Kansas Uses

Innovative Programs
To Prevent —
Hospitalization

by Patricia T. Schloesser, MD

Atthe turn of the century, a Kan-.

sas journalist, William Allen White,
became nationally known for his
editorial “What's the Matter with
Kansas?” His theme was that “when
anything is going to happen in this
country, it happens first in Kansas.”

Although Kansas has had many
“firsts” this century in public
health and mental health program-
ming, home care ventilator de-
pendent persons have not yet be-
come reality. Kansas does have,
however, a number of innovative
out-of-hospital programs designed
to prevent hospitalization in the
first place or when necessary, to
decrease the length of stay. This
preventive approach offers a more
normal life experience for the
handicapped andtheirfamilies and
is cost effective as well. Some pro-
files of programs follow.

Cystic fibrosis program

_ In 1966 the Kansas legislature
appropriated funds to the Depart-
ment of Health and Environmentto

develop services for all cystic fibro-
sis children in the state. Since the
appropriation was small, the de-
partment designed an out-patient
program which lessened the need
for hospitalization. Funds were
earmarked for the provision of

home inhalation equipment and
medications at. no.cost to the
families. Centralized. purchasing
resulted in considerable savings.
Diagnostic and case. management
clinics were established in Wichita
and Kansas City. A survey of parents
three years after this program was
begun, indicated that fewer hos-
pitalizations were necessary and
the family morale had been greatly
improved. Currently, there are 239
active patients on the registry with
30 over 21 years of age. Most CF chil-
dren are progressing inschool with
their peer group and are becoming
self-sufficient in early adulthood.
In recent years, the Crippled and
Chronically 11 Children’s Program
has paid for hospitalization for cys-
tic fibrosis patients whose families
are financially eligible. Third-party
reimbursement has also strength-
ened the financial base of the pro-
gram in recent years. In one urban
area, cystic fibrosis patients are
being discharged from the hospital
on intravenous therapy at home.
This has decreased the average
hospital stay from four weeks to
one.

Chronic obstructive pulmonary
disease (COPD)

The Kansas Lung Association

in cooperation with physicians
in urban and-rural areas is en-
couraging. home based programs
in which patients are taught 13
respiratory skills through indi-
vidual or group instruction using
a self-study manual. A decreased
need for hospitalization is an-
ticipated.

Diabetes-outpatient manage-
ment of the young diabetic
patient

The Kansas Medicaid program
has had some positive experi-
ences with the outpatient manage-
ment of severe diabetic children.

One of their patients is a 14-year

old girl who had been in a Wichita
hospital for a total of eight months
in a 12-month period including 32
days in intensive care, at a total
cost to the agency of $59,000.
Medicaid authorized the purchase
of an expensive piece of equip-
ment, an insulin pump, along with
a glucometer for monitoring, her
blood sugar, so that she could be
discharged home. The child has
remained home for 18 months with
no hospitalizations. The Medicaid
agency has now authorized the
purchase of additional insulin
pumps for two other teenagers
with equally good results. Dr.

Patricia T. Scholesser, MD, is medical director of the Maternal and Child Health Programs, State of Kansas, in Topeka, KS.

 
Richard Guthrie, Director of the
Kansas Regional Diabetic Center
in Wichita, reports that there are
64 persons currently ontheinsulin
pump at home managed by: this
center. He projects that the total
cost of the patient. workup and
equipment and supplies for the
first year would be about $8,000
compared to an average of $30,000
per year for repeated hospitaliza-
tions, With 64 patients a year, the
difference between home cost and
hospital cost is $1,300,000. If we
project this figure. nationally, such
@ program could save $50 million
per year.

Prevention of prematurity
programs

The cost of premature care
can best be illustrated by a case

history as follows. M.H. was born
prematurely and weighed slightly
over two pounds. His mother was
17 years old and had dropped out
of the 10th grade with the preg-
nancy. She had received late and
inadequate prenatal care. The in-
fant was transferred to the inten-
Sive care unit at a. Level! 3 hospital
in Kansas City by ambulance for
management of the prematurity
and associated respiratory prob-
lems: He: remained in care for 24
days and was returned to a Level 2
hospital in his homecommunity for
14 days of convalescent care. The
cost of this hospital care was
$50,000. This infant is developing
normally and = special education
costs have been avoided by the
excellent perinatal network pro-
gram established by the Maternal

and Chiid Health Block Program.

If the family had resided in acom-

munity with the special Maternity
and Infant Care Program for teen-
agers (there are 10 such programs
across the state), this mother
would have received improvedpre-
natal care andthe WIC supplemen-
tal food program with the likeli-
hood of preventing the birth of a
premature‘infant. Since the cost of
this preventive health service for
mother and infants averages
$2,000, a cost savings for this pa-
tient would be $48,000.

In summary, 1 would echo
William. Allen. White and Say,
“There’s nothing the matter with
Kansas” as Kansas responds with
practical approaches for home
based programs to meet the needs
of families: @