Category Archives: Healthcare Information and Trends

Tanning turmoil: Why getting ‘bronzed’ is hazardous to your teen’s health

For teens, one visit to a tanning bed increases the risk of squamous cell carcinoma by 67 percent. (iStock photo / Getty Images)

A guest post by Gigi Chawla, MD

Every spring, many of us weary from a long winter head south to warmer climes; teens across the country attend prom with their sweethearts. And what do kids tend to do before events like these?

Hit the tanning salon.

Looking “pasty white” in a swimsuit or a new dress just won’t do, right? Think again.

Here’s a brief warning to help dispel the myth of “getting a base tan” before these events. Or ever.

Currently, 35 percent of 17-year-old girls in the U.S. are using tanning beds and 55 percent of college-aged kids have used one at least once.

In Minnesota, the Star Tribune reported earlier this year that, “a third of white 11th-grade Minnesota girls have tanned indoors in the past year, according to a state survey … and more than half of them used sun beds, sunlamps or tanning booths at least 10 times in a recent 12-month period.”

What isn’t immediately clear to our kids is that during a tanning-bed session they may receive up to 12 times the ultraviolet (UV) exposure as they receive being outside in the natural sunlight. This UV radiation exposure from tanning beds is dangerous and linked to three types of skin cancer: melanoma, basal cell carcinoma and squamous cell carcinoma.

Here’s the potential damage that one tanning-bed session alone can cause a teen:

  • The risk of developing melanoma increases by 20 percent
  • The risk of developing basal cell carcinoma increases by 29 percent
  • The risk of squamous cell carcinoma increases by 67 percent

For people using a tanning bed under the age of 35, the lifetime risk of developing skin cancer of any type increases by 74 percent.

Specifically, it increases the lifetime risk of:

  • melanoma by 75 percent
  • basal cell carcinoma by 150 percent, and
  • squamous cell carcinoma by a whopping 250 percent

Moreover, skin cancer now is the leading form of cancer in 25- to 29-year-olds.

Another startling fact: More skin cancer cases arise from tanning-bed use than lung cancer cases do from smoking; yet, in our culture, bronzed skin is seen as a form of beauty.

Some advice to parents: Remember to reinforce to your teens that they are beautiful or handsome no matter the shade of their skin. What’s important is what’s inside. I like to think that we live in an era in which we can look past skin color, where we are not judged by skin color and we should not see beauty based on skin color.

It’s time to remind your kids to “go with your own natural glow.”

Gigi Chawla, MD, is a pediatrician, hospitalist and the Senior Medical Director of Primary Care at Children’s Hospitals and Clinics of Minnesota. Her areas of interest are the care of complex special needs patients, premature infants, ventilator dependent children and care of hospitalized patients.

Sources: The Skin Cancer Foundation, U.S. Food and Drug Administration, Centers for Disease Control and Prevention

 

Minneapolis among 10 best U.S. cities for health care

Minneapolis was named one of the 10 best U.S. cities for health care, according to Becker’s Hospital Review and a release from iVantage Health Analytics and its Hospital Strength INDEX, a rating system analyzing publicly available data to measure hospitals across 10 pillars of performance and 66 metrics.

Minneapolis was named one of the 10 best U.S. cities for health care. (2014 file / Children's Hospitals and Clinics of Minnesota)

List of cities in top 10 (in alphabetical order):

  • Atlanta
  • Boston
  • Charlotte, N.C.
  • Chicago
  • Minneapolis
  • New York
  • Philadelphia
  • Portland, Ore.
  • St. Louis
  • Washington, D.C.

The 10 cities serve approximately 60 million people, 19 percent of the U.S. population, according to the report.

Sources: Becker’s Hospital Review and iVantage Health Analytics

Influenza is now widespread in Minnesota. Here’s what you need to know.

By Patsy Stinchfield, MS, CPNP

Patsy is a pediatric nurse practitioner in infectious disease and the director of infection prevention and The Children’s Immunization Project at Children’s Hospitals and Clinics of Minnesota.

Update

Influenza is now “widespread” in 35 states, including Minnesota.

There is still time to get vaccinated if you and your family have not yet done so.

To learn more about how Children’s is helping prevent the spread of influenza in the community, click on over to www.childrensMN.org/flu.

This post originally appeared on the Mighty Blog on Jan. 2.

As of Jan. 2, 2014, the Minnesota Department of Health has declared influenza “widespread” across the state, the highest designation level. Over the past two weeks, influenza cases at Children’s have more than doubled, however they still remain below where they were at this time last year. Now that influenza has arrived, it’s likely that it will remain in full swing in Minnesota for the next two months.

So what can you do? The No. 1 way to prevent the flu is to get vaccinated. And it’s not too late. Anyone 6 months of age and older who has not received their flu vaccine should do so now. Most clinics and pharmacies are still vaccinating and have a good supply of vaccine. The most common influenza strain we’re seeing is the H1N1 strain which is contained in this year’s vaccine. In addition to getting the vaccine, we also recommend frequent hand washing and avoiding touching your eyes, nose or mouth prior to washing your hands to help prevent the spread of illness.

If the flu has already reached your house, here are few helpful tips for caring for your child while they’re ill.

What’s the difference between the cold and the flu and how can I tell?

Sometimes it’s hard to know whether a child has a cold or the flu because she may cough, have a runny nose, sore throat and fatigue with both. However with the flu, a child tends to have a high fever which comes on more suddenly and may include severe fatigue and body aches. Colds tend to come on more gradually, and many kids may feel well enough to keep playing and going to school with a cold. Clinics may use a rapid nose swab test to determine if someone has influenza.

What should I do if I suspect influenza?

Most cases of influenza are mild and can be managed at home with rest, plenty of fluids, and fever-reducing medicines. Tender-loving care is good medicine, too. Most over-the-counter “cough and cold” medicines do not help a sick child get better faster and won’t have much effect on influenza. Sometimes, the flu can make a child very ill and a visit to the clinic or emergency room is necessary.

When should I take my child to the emergency department?

Take your child to be checked if they have difficulty breathing (fast, grunt-sounding, noisy breathing or small breaths), if their color looks bad (pale or bluish), if they aren’t drinking fluids often or urinating at least once every eight hours, or if they just aren’t themselves and you’re worried. Signs of dehydration are dry lips, sunken eyes, sleepiness or crankiness. Children who seem like they’re getting better and then suddenly get worse should be taken to the Emergency Department immediately. This could mean they have another infection such as pneumonia in addition to the flu.

What are the best ways to get my child’s fever down when she has the flu?

Fever is one of the tools our immune system uses to kill germs. However, children with high fever can feel quite miserable, get crabby, have trouble waking up and may drink less fluids causing dehydration. If you can’t keep the fever down with a fever-reducing medicine such as Tylenol or ibuprofen, then the child should be taken to the clinic or emergency department.

Is there anything else I can do to help make my child more comfortable?

You can keep your child home from day care, school, sports or other activities and have them rest early in their illness until they show signs of getting back to “their normal.” If your child doesn’t want to eat regular meals, don’t insist, but do make sure they drink small amounts of fluids every hour to prevent dehydration.

Is there anything I can do to help my child recover more quickly?

There is an anti-viral medicine called Tamiflu that can be given to children as young as 2 weeks of age. This is used if the child is hospitalized with moderate or severe influenza or if the child is outpatient but at higher risk for complications from influenza. These would be children with immune system problems or neurological, pulmonary, or metabolic underlying conditions. Tamiflu works best if given in the first two days of illness which can cut the severity and number of days of illness in half.

How long will my child be contagious?

Influenza is most contagious the day before symptoms present through about day four of illness. Your child should stay home from school during this time. After viral illnesses, kids can have lingering muscle or body aches and really do need time to rest and recover before rushing back to school. They can often pick up other viruses easily and may have a lingering cough as their airway heals. Depending on the severity of the flu, this may be a few days to a few weeks. Most kids recover within a week. Remember that many schools require that your child be fever-free (without the help of medicines) for one to two days before returning to school or day care.

World AIDS Day: Getting to zero

Fatumata, whose name has been changed, is a 14-year-old girl who lived in Eastern Africa all of her life before coming to Minnesota in 2010. She grew up in a refugee camp with her younger brother and sister and her parents. She had to take medicine every day, and sometimes she was very sick. But mostly she liked to play with her friends and help her mother with the chores.  Fatumata noticed that some of the people in the camp avoided her and her family, and she was not allowed to go to school with the other children. She didn’t know why.

Then one day, Fatumata’s father became very ill and eventually passed away.  Soon after, her mother became too sick to care for her and her siblings, and her uncle came to tell her that she would be leaving the camp to go and live with his family in America. Fatumata cried because she did not want to leave her mother, but her mother told her that she would be able to grow and be healthy where she was going and that they would see each other again.

So Fatumata and her siblings came to Minnesota. It was very cold and, at first, she didn’t understand what anyone was saying.  Soon she was able to go to school for the first time, and she learned English, and she continued to take her medications and grow strong and healthy. Today, Fatumata knows why she takes medications. She knows the name of her disease and doesn’t fear her HIV. She has a dedicated medical team at Children’s who provide care and support to her and her family. Fatumata is looking forward to the day when she will be able to go to college and some day, have a healthy family of her own.

Dec. 1 marked the 25th anniversary of World AIDS Day.  It is an opportunity for us to come together to show support for people living with HIV and AIDS around the world and at home, to remember those who have died from this disease, and to commit to “getting to zero” in the fight against HIV:  zero new infections and zero deaths from HIV and AIDS.

HIV today

Around the world, there are an estimated 34 million people living with HIV. About 3.3 million are children under 15.  In addition, around 17.3 million children have lost one or both parents to AIDS and millions more have been affected by the epidemic. Every day, almost 7,000 people become infected with HIV and nearly 5,000 people die from AIDS.  In 2011, 230,000 of those who lost their lives were children, according to UNICEF.

In the United States approximately 1.1 million people are living with HIV, and in Minnesota, just over 7,500 of our neighbors, family members, and friends are living with HIV and AIDS, according to the Minnesota Department of Health.

What is Children’s doing in the fight against HIV?

As the largest provider of care to HIV-infected children in Minnesota, we provide medical care to more than 100 children infected with HIV every year.  Children come to us from all over Minnesota and all over the world. Many of the children in our care have been adopted from countries in Asia, Africa, Eastern Europe, and the Caribbean.  Many more are refugees and immigrants, who may not be able to access treatment in their own countries. In addition to expert medical care, families can access specialized support services funded through the federal Ryan White CARE Act, including education, family case management and mental health services.

What can you do?

1. Get tested, know your status! HIV testing is recommended as a routine part of medical care.Talk to your provider about testing.

2. Get connected, get support! If you are living with HIV, find out about the programs and services offered in your area to help you stay healthy and support you and your family in living with your disease.

3. Educate yourself about HIV! Learn how to prevent HIV infection and how to keep yourself safe. Can you answer these questions about HIV?

True or false?

1. HIV is a virus and AIDS is a bacteria

2. HIV infection can be spread by hugging

3. Some people have HIV and do not know it

4. There is treatment for HIV

5. People who have HIV can give birth to healthy babies

Quiz answers

1.  HIV (human immunodeficiency virus) is a virus and AIDS (Acquired Immune Deficiency Syndrome) is the disease caused by the HIV virus. AIDS makes it hard for people to fight off other kinds of infections and illnesses and can make people sick.

2.  False! You cannot get HIV from hugging or playing with other people with HIV. HIV can only be spread by direct contact with blood and some other body fluids through sex, sharing needles, or breastfeeding.

3.  True. About 15 percent of people infected with HIV do not know they are infected with the virus. That’s why getting tested is so important!

4.  True! We have great treatments and medications for people living with HIV that enable them to stay healthy and live a very long time. We don’t have a cure yet, but scientists are hard at work on it.

5.  True! When people living with HIV take their medications and see their doctors regularly, they have over a 98 percent chance of having a baby born without HIV.

Nine health applications for parents

We at Children’s Hospitals and Clinics of Minnesota have launched our first official iOS application to better serve our community. The app is a guide to help make the experience for our families the best, and it includes hospital maps, news and events, and the ability to find Children’s clinical staff and locations. Learn more about the app here.

As we launch our app, we also want to suggest other health apps. Here are eight you might find helpful.

iTriage application: The iTriage application not only allows you to check out what the symptoms you’re suffering from might mean, but locates nearby clinics and doctors. You can even save information about Children’s Hospitals and Clinics of Minnesota clinics, and get turn-by-turn directions on how to get here if needed. The app also allows you to save appointment details and history within the app for easy reference later on.

Instant Heart Rate: The Instant Heart Rate app uses the camera on your smartphone to measure the pulse from your finger. Simply place the tip of your index finger on the phone’s camera, and in a couple of seconds your pulse will be displayed. The app even features a real-time pulse chart to show you every heartbeat.

Ibitz: One way to keep your child healthy is simply to encourage a healthier lifestyle. Ibitz is a combination of an app and fitness tracker that not only keeps track of how active your child is, but allows them to earn points to play their favorite video games or watch TV. You as the parent decide how many points are needed and what the rewards are, encouraging your child to be more active during the day.

My Kid’s Health: My Kid’s Health is an iPad app to help parents with their children’s medical information. The app allows to track vaccination records, growth charts, appointment cards and medical records right on their iPad.

iHealthTrax: iHealthTrax is an app that lets you keep track of who’s been sick, what the symptoms are, and how long it’s lasted. The app features a calendar that lets you mark illnesses, medication, and symptoms. The app allows for multiple calendars, so you can track each family member on their own calendar and keep the details in order. This can be especially helpful for organizing your information when going to the pediatrician’s office.

WebMD: The WebMD app is a companion application to the popular website. The app allows you to research conditions and symptoms and access medication and treatment information. The app also provides advice and first aid tips.

WebMD Baby: The WebMD Baby app is a baby-specific app that comes packed with information for new parents, featuring 400 articles, 600 tips and 70 videos. The app offers parents guidance on what to expect from their baby’s physical and emotional development and has access to health-related counsel when issues come up.

CaringBridge: CaringBridge for iPhone and iPad makes it easy to stay connected to your family and friends while you’re out and about. The CaringBridge app syncs up with the CaringBridge service, which offers free personalized websites to people facing serious medical conditions or hospitalization to allow their friends and family to follow along, stay up-to-date on any developments, and offer words of encouragement.

 

Making a safety list and checking it twice

This is a post by Dr. Rod Tarrago, a pediatric intensive care physician at Children’s Hospitals and Clinics of Minnesota.  He is also the Chief Medical Information Officer and is proud to admit he’s a computer geek.  He’s been helping improve the care at Children’s through the use of technology and spends most of his time helping other clinicians improve their understanding of the computer system. He’s the proud father of two young boys and future computer geeks. 

For nearly three years, the Pediatric Intensive Care Unit (PICU) at Children’s has been using a time-tested technique to improve care of patients: a safety checklist. It’s well known that it’s very difficult — if not impossible – for the human brain to truly multitask.

Unfortunately, in an ICU environment, where patients are sick and their illnesses complex, clinicians have to integrate a lot of information and make many decisions on a daily basis. There are also many “typical” tasks that need to be accomplished for every patient, every day.

In order to help the team remember to address all of these items, we’ve been using a safety checklist as part of our work since 2010.  In St. Paul, we go through this checklist during patient rounds.  In Minneapolis, since the unit is larger and busier, we do special “Safety Rounds” later in the workday.

On both campuses, the entire care team, including physicians, nurses, pharmacists, respiratory therapists, and nutritionists, comes together every day to go through the “standard list” of 23 safety items. These include reminders to check the need for IV and bladder catheters, make sure that antibiotics are needed, and order new labs each day. Each clinician specialty “owns” individual items and then brings them to the group for daily discussion, making sure that everyone is on the same page. Initially, we started this project by using a laminated paper checklist that was placed at each bedside. After losing too many checklists, we moved to an electronic checklist that is embedded in each child’s electronic medical record or EMR.

We recently examined 21 months’ worth of data after using the checklists and found some exciting results:

  • By asking whether we really needed catheters, we reduced the use of these catheters by anywhere from 25 to 45 percent. We also found that we used those catheters less.
  • By asking ourselves whether any medications can be given either orally or through a feeding tube instead of through an IV, we cut costs to families. We examined one medication, a diuretic, and found that by using the checklist, we used an IV 46 percent of the time instead of 77 percent of the time.  By using IV catheters less often, we reduce the risk of catheter infections. It’s also less expensive to give a medication orally compared to through the IV.  We saved patients’ families more than $64,000 over the study period by making these changes.
  • By simply discussing the need for antibiotics each day making sure that we identified ahead of time how long the antibiotics should last, we lowered our use of antibiotics.  In fact, by entering this information into the patient’s EMR, we found that we gave one less dose per patient each day.
  • Prior to the checklist, we ordered labs several days in advance. Now, the checklist reminds us to order them each day and discuss the need for each lab.  By doing this,  we reduced the number of labs we ordered by almost six labs per patient per day. This saves a family $500 a day in lab charges.

You may use a checklist at home or to run errands. In medicine, it’s a relatively new concept that’s only beginning to grow in popularity. But in our PICU, it’s the standard.

 

 

Using technology to keep kids safe

This is a post by Dr. Rod Tarrago, a pediatric intensive care physician at Children’s Hospitals and Clinics of Minnesota.  He is also the Chief Medical Information Officer and is proud to admit he’s a computer geek.  He’s been helping improve the care at Children’s through the use of technology and spends most of his time helping other clinicians improve their understanding of the computer system. He’s the proud father of two young boys and future computer geeks. 

Dr. Rod Tarrago

We’ve been using computers to help take care of kids at Children’s for several years. We order medicines, track kids’ vital signs, and look at X-rays on computers. Now, we’re starting to use more advanced technology to make sure we keep kids as safe as possible. Many of the children we treat have complex cases and require various medicines. That can be very confusing and potentially dangerous for those taking care of the patient. Can you imagine trying to keep perfect track of a patient who has more than 30 medicines, especially when doses and times are changing?

Recently, we’ve started using familiar technology – medication scanners – in our Minneapolis Pediatric Intensive Care Unit (PICU). The scanners are similar to those used in other industries where a scanner checks a bar code to make sure it’s the right product. In our case, patients and families may have seen our nurses and respiratory therapists “scanning” the kids’ medicines prior to giving them.  Just as we previously were checking our patients’ ID bands to make sure the right medicine was being given to the right child, we’re now using the computers to make sure that it’s the right medicine at the right time with the right dose via the right route to the right patient. Children’s is the first pediatric hospital in the nation to use this technology.

Our nurses, respiratory therapists and information technology departments worked hard to make sure that the rooms were set up correctly and that the scanners worked for all medicines. They even changed the labels to make sure wrinkles were less likely to interfere with the scanning. They also came up with some creative solutions to lower the volume so that the beeping of the scanners wouldn’t wake up the kids at night.

In the busy Minneapolis PICU, nurses scan more than 2000 medications every week, and this has helped us detect several instances in which medications might have been given early or late.

At Children’s our No. 1 priority is to keep our patients safe and help them get better.  By using our new scanner technology to more safely deliver medicine to the kids, we are staying at the forefront of medicine. Over the next few months, we’ll extend this important technology to other units at Children’s.

 

Future of Private Practice

Phil Kibort, MD

A recent article from the Minnesota Hospital Association’s Ebriefing, by Dr. Daniel K. Zismer, who is the associate professor and director of the MHA and Executive Studies Program, conveyed why he feels that there are significant challenges to the private practice business model in our futures.

No doubt there will always be some room for private practice. He feels that there are six common challenges that are causing private practice models to be stressed and thus leading to more and more physicians wanting to be employed with hospital systems.

Those pressures are the following:

  1. the cost of electronic health records. It is staggering for groups to have to implement an electronic health record. It is neither a luxury nor a strategic differentiator any longer but is rather a required ticket to relevancy he says. We will need it to be part of an accountable care organization and to be relevant to the consumers in health care into the next decade.
  2. Health systems can outspend private practice for physicians. The larger the system the more money they have available to go out and seek the more specialists, and especially the higher end specialists, while private practice has difficulty. For those who want to be employed there is no practice investment.
  3. Reimbursement lightning strikes. The larger the organization the more they are able to handle quick strikes by the government or the payers of reimbursement problems. While the larger systems also have this difficulty it is not to the same degree.
  4. Young physicians wants and needs. Almost 85 to 95% of residents and students coming out of residency want to be employed. They no longer are looking for the private practice model.
  5. Routine practice overhead inflation curves. Groups are having a more difficult problem keeping up with the inflation cost of operations, thus physicians take home less compensation. Independent physicians will endure this dynamic until the economics of private practice become unsustainable.
  6. Routine practice recapitalization – It is getting harder to find dollars to capitalize things. These forces are out there for everyone and will continue to be a cultural change that is occurring in medicine.

Phil Kibort, MD, is Children’s vice president of medical affairs and chief medical officer. Read his bio here.

New Children’s Hospitals and Clinics Report Highlights Minnesota’s Declining Immunization Rates

By Patricia Stinchfield, RN, MS, CPNP, Director of Pediatric Infectious Disease & Immunology Infection Control

Patsy Stinchfield

The case of measles detected last week in Minnesota revives strong memories for me of Minnesota’s measles outbreak in the early 1990s. Child health care providers back then will never forget the panic among parents, the babies on ventilators, and the ones who did not survive.

We pay close attention when there is a case of measles because the disease is so highly contagious that even just one case is considered epidemic. While state health officials are still monitoring the confirmed case reported last week, it serves to show that vaccine-preventable diseases continue to be a problem. And that problem may well be due to a worrisome trend we see occurring not just in Minnesota but across the country.

Declining immunization rates.

This trend has the attention of Children’s Hospitals and Clinics of Minnesota. As part of our series of reports on the health of Minnesota’s children called “Children’s Check-Ups,” we decided to take an in-depth look at immunization rates among Minnesota’s children, where they were slipping and why. Our report, called “Check-Up 2: Vaccinations and the Challenges Confronting Minnesota Children,” is now released and can be found at www.childrensmn.org/about-us/childrens-check-ups-series.

We found that Minnesota’s immunization rate for children ages 19 months to 35 months dropped 3.6 percentage points from 2007 (80.5 percent) to 2009 (76.9 percent). As a result, Minnesota’s rank in immunization dropped to 20th place in 2009 from the seventh in 2007. We saw similar drops in vaccinations against measles, mumps and rubella (MMR), diphtheria, tetanus and whooping cough (DTaP and Tdap), and chickenpox vaccine.

Quite simply, the lower the immunization rate, the more likely the disease will spread. Even a one percentage point drop is cause for concern when you consider that it means that more than 4,200 young Minnesota kids are left unprotected.

Last year, we saw a resurgence of whooping cough in Minnesota, which threatens to recur this year. Our report notes declines in whooping cough vaccination rates among young kids, and a poor showing among adolescents for the booster shot version.

We found two powerful forces contributing to declining immunization rates. The first is disparities in care, often linked to poverty, which limits access to vaccines among certain populations. The second is a growing mix of complacency, misinformation and misunderstanding that keeps parents from protecting their children against vaccine-preventable disease.

I had the opportunity to talk about these issues during Minnesota Public Radio’s Midmorning program on Tues., March 8. You can download the podcast here. We hope our report, by providing a clear, factual and in-depth look at these issues, can serve as a resource to inform parents, government leaders, health care providers and advocates about these issues, and to spark a meaningful and productive discussion of how to better protect our kids. They are counting on us to protect them.

Additional Resources:

  • Patsy Stinchfield, joins Good Enough Moms hosts Marti Erickson and Erin Erickson to discuss why vaccinations are important, how they have prevented the spread of disease in the U.S. and how being immunized also protects the people around us. Listen to the podcast

Why Are Children’s Hospitals Necessary?

Now I admit an inherent bias in my thinking, but the question arises constantly: Why do you need a free and independent children’s hospital versus a children’s hospital within a larger system?  Is it because of my job at Children’s when I think in these terms or is there some data behind thinking this is better for children?

A recent white paper by the Chartiss Group that was presented to CEOs of children’s hospitals discussed the evolving nature of these hospitals in light of what is happening in our economy. They remind us that birth rates have declined dramatically over the past few years, which of course will have a great impact for us over the next four to five years.  Hospitals that take care of children are seeing an increasing prevalence of chronic diseases and an increasing prevalence of children with technology dependencies.  Both of those groups have an increasing demand for pediatric services.  At the same time, we are seeing thankfully a greater and significantly improved survival rate. Along with this there is a major increase in the growth of obese populations and socioeconomic shifts in Medicaid.  There are more and more children having their care done in the outpatient world and there has been a reduction in neonatal discharges.

What the Chartiss Group found was that the adult hospitals and adult systems do not have the ability to compensate for volumes and other service lines, thus the country is seeing an increased consolidation of pediatric care, more and more within free-standing children’s hospitals.

Also, a few years ago we felt there might be a 3 percent annual growth in pediatric patient days; in reality it is now closer to just 1 percent.  Between 2003 and 2009, the number of patients with at least two or more complex, chronic conditions admitted to hospitals went from 5.6 to 7.7 percent and those children with technology dependencies went from 10.9 to 13 percent.  What we also know is that when the Medicaid population goes up, their utilization of hospitals also goes up.

What was most important — and for all of you out there who sometimes wonder if you should be taking care of children in community hospitals or hospitals within hospitals — to remember is that there is also superior, quality performance at children’s hospitals.  Outcomes at free-standing children’s hospitals are better. Their actual mortalities percentage of expected mortality is lower whether it is in complex children or technology dependent children.

In this healthcare economy, we also have to look upon price.  Children’s hospitals need to differentiate themselves based upon low-cost services, access and quality; they need to promote innovative care models to better leverage subspecialties; align with community; and access additional market opportunities to preserve regional positions.  They also need to invest in an achievable set of destination programs, begin partnership discussions with dominant adult systems, manage financial performance, prepare for Medicaid fee reductions and improve performance. We must also rapidly develop contingency to manage population and work with health plans in the state to shape payment reform.

It’s scary, but also leaves us with great opportunities.

Phil Kibort, MD, is Children’s vice president of medical affairs and chief medical officer. Read his bio here.