Pediatric Year in Review

PEDIATRIC YEAR IN REVIEW 5 UPDATE IN THE MANAGEMENT OF AERODIGESTIVE PROBLEMS IN THE PULMONARY CLINIC UPDATE IN THE MANAGEMENT OF AERODIGESTIVE PROBLEMS IN THE PULMONARY CLINIC Erik B. Hysinger, MD, MS Cincinnati Children’s Hospital Medical Center Department of Pediatrics, Division of Pulmonary Medicine Cincinnati, OH STRUCTURE AND FUNCTIONS OF AERODIGESTIVE PROGRAMS Boesch RP, Balakrishnan K, Acra S, Benscoter DT, Cofer SA, Collaco JM, et al. Structure and Functions of Pediatric Aerodigestive Programs: A Consensus Statement. Pediatrics. 2018; 141 (3): DOI: 10.1542/peds.2017-1701. Summary Aerodigestive programs provide coordinated care for children with complex conditions affecting breathing, swallowing, and growth. While there has been a tremendous growth in the number of aerodigestive programs across the country, there is a lack of consensus in the definition of an aerodigestive patient, structure and function of aerodigestive programs, and research priorities in aerodigestive medicine. The Delphi method was used to generate a multidisciplinary and multi-institutional consensus statement from 33 specialists at 11 established aerodigestive programs. There was nearly 100% response, and consensus was achieved for virtually all items. An aerodigestive patient is defined as “a child with a combination of multiple and interrelated congenital and/or acquired conditions affecting airway, breathing, feeding, swallowing, or growth that require coordinated interdisciplinary diagnostic and therapeutic approach to achieve optimal outcomes.” Essential team members for all patients included a care coordinator, gastroenterologists, nurses, otolaryngologists, pulmonologists, and speech-language pathologists. Essential procedural skills for pulmonologists participating in aerodigestive programs include BAL, bronchial brushing, TEF identification, fiberoptic intubation, sleep state bronchoscopy, endobronchial biopsy, foreign body removal, and balloon dilation; essential skills were also defined for gastroenterologist and otolaryngologists. Further, the structure and function of an aerodigestive program, research priorities and key outcome measures are also identified. Comments 1. This is the first report to define an aerodigestive patient as well as the structure and function and research and outcome priorities for aerodigestive teams. 2. Identification of key outcomes and research priorities will help to develop clinical guidelines, standardize care, and improve quality. 3. The strength of this study is the use of experienced providers from multiple disciplines and institutions, high response rate, and ability to achieve consensus. 4. The primary weakness of this study is the lack of available data from which to make recommendations, though this presents an opportunity for future investigations. HEALTHCARE OUTCOMES IN AERODIGESTIVE Appachi S, Banas A, Feinberg L, Henry D, Kenny D, Kraynack N, Rosneck A, Carl J, Krakvotiz P. Association of Enrollment in an Aerodigestive Clinic with Reduced Hospital Stay for Children with Special Health Care Needs. JAMA Otolaryngol Head Neck Surg. 2017; 143(11): 1117-1121. Summary Childrenwithspecial healthcareneedshavedisproportionate health care utilization and incidence of hospitalization; however, there is little evidence that evaluates the efficacy of multidisciplinary aerodigestive programs in themanagement of complex patients. This was a retrospective cohort with 113 children that evaluated hospital admissions before and after enrollment in a multidisciplinary aerodigestive clinic. All causes of hospital admissions and aerodigestive specific admissions were assessed. Children enrolled in the study had a broad range of aerodigestive disorders, and the majority of subjects (52.2%) were under 5 years of age. While there was not a significant decrease in hospital admissions, total hospital days were reduced by 4.1 days/ year, and there was a reduction in hospital days by 6.8 days/year related to aerodigestive conditions. Comments 1. Multidisciplinary aerodigestive programs can result in decreased hospital days for children with special health needs. 2. This study supports that aerodigestive programs can have a posi- tive impact on patient outcomes and cost of health care. 3. The lack of a control group not enrolled in an aerodigestive pro- gram and retrospective review are the primary limitation of this study. Boesch RP, Balakrishnan K, Grothe RM, Driscoll SW, Knoebel EE, Visscher SL, Cofer SA. Interdisciplinary Aerodigestive Care Model Improves Risks, Costs, and