December 21, 2011 / 6:35 PM / 6 years ago

Decision sharing tied to lower cost for kids' care

NEW YORK (Reuters Health) - Parents who report having an increased involvement in making decisions about their children’s medical treatment are more likely to see lower risks of their kids going to the emergency room or being hospitalized, according to a new study.

The researchers, who looked only at families with children who have long-term health conditions, also found that those who joined doctors in making medical decisions had lower costs for their kids’ medical care.

“This suggests that if you involve people in decision-making, they may be making choices that lead to decreasing the financial burden on them,” said the study’s lead author, Dr. Alexander Fiks, a professor at the Children’s Hospital of Philadelphia.

Cost is especially important for these families, Fiks told Reuters Health, because there’s a large out-of-pocket burden for kids who have asthma, autism or other chronic health problems.

His study, published in the journal Pediatrics, used responses from a large, annual health care spending survey, and they compared the results over two years.

The parents of more than 2,800 kids with special health care needs answered questions not only about costs, but the relationship they had with their child’s doctor.

For instance, the survey asked how often doctors invited the parents to help in making decisions about treatment, and how often health care providers listened carefully to the parents.

Shared decision-making in medicine is considered a relatively new approach to determining a plan of treatment for patients, compared to the older, more paternalistic approach of the doctor calling the shots without input from the family or patient.

Fiks and his colleagues found that about half of the families experienced a high level of shared decision-making with doctors over the two years, while 17 percent continued to have a low level of participation.

About 16 percent of the families played an increasing role in making decisions over the span of the study, which was linked with a drop in trips to the hospital.

In the first year, seven out of every 100 kids in this group of families were admitted to the hospital, compared to three out of every 100 kids in the second year of the study.

Similarly, 26 out of every 100 kids went to the E.R. in the first year, compared to 15 in the second year.

Dr. Stephen Berman, a professor of pediatrics and public health at the University of Colorado and a medical editor of the Foundation for Informed Medical Decision Making, said he wasn’t surprised to see these kids avoiding the hospital.

“In my own practice I find that when parents become partners in these decisions...they understand the care plan much better and they’re much more compliant with giving medications (to their kids) and recognizing danger signs,” said Berman, who was not involved in this study.

“If families are following treatments more closely, it’s possible that the kids may get better,” Fiks said.


Health care spending for kids also dropped in the second year of the study if families had a growing part in making decisions.

The total spending on health care was more than $2,000 in the first year, and dropped to about $1,700 in the second year.

Fiks and his colleagues didn’t prove that sharing decisions was the sole reason for the benefits they saw.

There are other possibilities that could explain why the researchers found a benefit for families who took a larger part in making choices in the second year.

For one, parents who are stronger advocates for their children -- and who are more likely to aggressively pursue treatments -- might seek out doctors willing to involve them in making decisions.

Another explanation is that as children get sicker, their parents might be less willing or able to make choices, and the decisions fall primarily on the doctor. On the flip side, as kids gets healthier, their parents might be more able to take on a greater role in their care.

Fiks said he’d like to see future studies work out whether shared decision-making alone can result in cost savings and health benefits for children with health problems.

“I personally believe that when we do those studies...we will find an impact from shared decision-making,” Berman told Reuters Health.

SOURCE: Pediatrics, online December 19, 2011.

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