Managed Care - January 2009 - (Page CB-B6)

Steps to creating an effective RSV program for high-risk infants A managed care analysis by Norman White, MD Medical Director, Presbyterian Health Plan, Albuquerque, N.M. hrough the use of successive hospital discharge and continues throughout an infant’s first RSV quality-improvement cycles, season. Presbyterian Health Plan The use of standardized forms, (PHP) has evolved an effective originating in contracted NICUs process to reduce the impact of and primary care offices, is RSV disease in the highan important component of risk infant population. PHP’s RSV management Timely and appropriate process. Initial information identification of high-risk about a high-risk infant is infants, particularly infants conveyed to the primary born 35 weeks gestation care provider prior to outand less who have two or patient follow-up using more documented risk facNorman White, common forms that have tors, is the first step and been developed in collaborequires the participation MD ration with local pediatric of the neonatalogy treatclinicians and health care insurers. ment team, including the physiContinuity of care is reinforced cian, nurse, pharmacist, and discharge planner, as well as the NICU by the PHP program coordinator and home health agencies that team and hospital case managers. work with the identified infants RSV management begins prior to T and their parents or caregivers to follow through with the RSV management program during the first RSV season. The program’s season is determined by the historical time frame for RSV occurrence in New Mexico, together with current season information provided by the local virology lab in Albuquerque. The anticipated onset of the season is November 1, while monitoring of current data allows for the ability to initiate program activity sooner if warranted. Similarly, the end of the RSV season is monitored for the decreasing incidence of RSV isolates, with termination of the program typically at the end of April. Managed care payers should be cognizant of the potential ramifications of severe RSV disease in infants. Developing a proactive RSV management strategy can help improve health outcomes and reduce unnecessary hospital resource use. References AAP (American Academy of Pediatrics). Respiratory syncytial virus. In: Pickering LK, ed. Redbook: 2006 Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, Ill.: American Academy of Pediatrics; 2006:560–566. Anderson LJ, Parker RA, Strikas RA, et al. Day-care center attendance and hospitalization for lower respiratory tract illness. Pediatrics. 1988;82:300–308. Arnold SR, Wang EEL, Law BJ, et al. Variable morbidity of respiratory syncytial virus infection in patients with underlying lung disease: a review of the PICNIC RSV database. Pediatr Infect Dis J. 1999;18:866–869. Boyce TG, Mellen BG, Mitchel EF Jr, et al. Rates of hospitalization for respiratory syncytial virus infection among children in Medicaid. J Pediatr. 2000;137:865–870. Carbonell-Estrany X, Quero J, and the IRIS Study Group. Hospitalization rates for respiratory syncytial virus infection in premature infants born during two consecutive seasons. Pediatr Infect Dis J. 2001;20:874–879. Carroll KN, Gebretsadik T, Griffin MR, et al. Maternal asthma and maternal smoking are associated with increased risk of bronchiolitis during infancy. Pediatrics. 2007;119:1104–1112. Celedon JC, Litonjua AA, Weiss ST, Gold DR. Daycare attendance in the first year of life and illnesses of the upper and lower respiratory tract in children with a familial history of atopy. Pediatrics. 1999;104:495–500. Cilla G, Sarasua A, Montes M, et al. Risk factors for hospitalization due to respiratory syncytial virus infection among infants in the Basque country, Spain. Epidemiol Infect. 2006;134:506–513. DHHS (U. S. Department of Health and Human Services). The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General (full report). «www.surgeongeneral.gov/library/secondhandsmoke». Accessed Sept. 5, 2008. Figueras-Aloy J, Carbonell-Estrany X, Quero J, for the IRIS Study Group. Case-control study of the risk factors linked to respiratory syncytial virus infection requiring hospitalization in premature infants born at a gestational age of 33–35 weeks in Spain. Pediatr Infect Dis J. 2004;23:815–820. Hall CB, Douglas, RG Jr., Geiman, JM. Possible transmission by fomites of respiratory syncytial virus. J Infect Dis. 1980;141: 98–102. Hall CB, Hall WJ, Gala CL, et al. Long-term prospective study in children after respiratory syncytial virus infection. J Pediatr. 1984; 105:358–364. Holberg CJ, Wright AL, Martinez FD, et al. Child day care, smoking by caregivers, and lower respiratory tract illness in the first 3 years of life. Pediatrics. 1993;91:885–892. Holman RC, Shay DK, Curns AT, et al. Risk factors for bronchiolitisassociated deaths among infants in the United States. Pediatr Infect Dis J. 2003;22:483–489. 6 http://www.surgeongeneral.gov/library/secondhandsmoke

Table of Contents Feed for the Digital Edition of Managed Care - January 2009

Managed Care - January 2009 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Health Care's Disruptive Innovations Q&A With Clayton Christensen 'Disruption' May Be Plans' Best Bet Avoid the PBM Rebate Trap HealthPartners Puts Diabetes on Notice Formulary Files Plan Watch Tomorrow's Medicine Ad Index Outlook Unmet Needs in the Management of Plaque Psoriasis Impact of RSV: Implications for Managed Care

Managed Care - January 2009

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