The Rising Cost of Treating Youth With Chronic Abdominal Pain
Study investigates factors affecting health care costs for youth with abdominal pain
Chronic abdominal pain is a common problem in children and adolescents, with more than 13% of youth affected worldwide. Most will not be diagnosed with an identifiable organic disease but will have symptoms consistent with an abdominal pain-associated functional gastrointestinal disorder (AP-FGID). The costs to evaluate and treat patients with AP-FGIDs have risen rapidly in the last several years, and up to 30% of cases persist into adulthood. Craig M. Friesen, MD, Medical Director of the Abdominal Pain Program at Children’s Mercy Kansas City; Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; and Clinical Professor of Pediatrics, University of Kansas School of Medicine, is studying data from across the United States to determine which factors most affect treatment cost and identify ways to disrupt the pattern and enhance treatment value.
Identifying Key Factors in Treatment Cost for Pediatric Abdominal Pain
In research published Nov. 1, 2021, in Children,1 Dr. Friesen and team sought to assess cost variability in the care of AP-FGIDs across health systems, races, and specific AP-FGID diagnoses. Using the Cerner Health Facts® database, Dr. Friesen identified 17,287 encounters, of which 38.7% had total cost data available. Statistical analysis of those encounters revealed considerable variation in costs both within and across health care systems. Variability by race/ethnicity was also significant, with generally higher costs for Hispanics and lower costs for Native Americans.
Unfortunately, while the database provides total encounter costs, costs for specific tests or treatments were not widely available and thus what drives the costs could not be discerned. Also significant, the database does not allow reliable assessment of treatment outcomes, which is key in understanding the value of different treatment options. Though there is a goal to disrupt the pattern of rising costs, Dr. Friesen emphasizes that cost alone cannot determine value. Higher short-term costs are not inherently bad if they provide better outcomes for the patient. With this research, Dr. Friesen is aiming to change the conversation from decreasing cost to increasing value and consideration of outcomes in the decision-making process.
Shifting Care Locations From Emergency Departments to Clinics
In a second study, Dr. Friesen focused primarily on determining patterns of care locations for pediatric AP-FGID patients, as well as how gender and race affected those location patterns.2 A secondary aim was to investigate the cost variability within the emergency department (ED). This project also used the Cerner Health Facts® database to identify 53,750 patients between the ages of 8 and 17 for assessment. Dr. Friesen’s team concluded that the emergency department was the most common location for care, and often the only location for Hispanic and African American patients.
To Dr. Friesen, this data suggests the existence of barriers to outpatient clinic access and/or affordability for nonwhite or low-income patients, some of which could be addressed on an individual level when ED care providers refer patients to outpatient clinics. He acknowledges that some issues, such as treatment cost, transportation cost or neighborhood safety, cannot be resolved at the hospital level. Further study is needed to gather sufficient data to garner support for multidisciplinary clinics at institutional or even national levels.
Shifting treatment location from the ED to an outpatient setting is critical not only for managing costs but also for providing more thorough evaluation and care. Patients with AP-FGIDs typically have a variety of psychosocial issues, such as anxiety, depression or sleep disturbances. One of Dr. Friesen’s goals with this research is to develop additional resources for ED personnel, to educate them on the need and pathway for referring patients to clinics.
Dr. Friesen notes that treating abdominal pain can be complicated. For most patients, symptoms do not get better with medicine alone. The associated psychosocial issues must be addressed, which cannot take place in an ED setting. Care needs to be provided in a multidisciplinary clinic with planned care across all aspects of the illness.
Both studies indicate sufficient variability in care models and costs to support future multisite studies on the value of specific tests and treatments. Such research could lead to the development of guidelines for evaluation and treatment of AP-FGIDs, which could improve patient outcomes while also reducing costs.
Dr. Friesen concludes that treatment costs for this disease are significantly higher than necessary, and that they are directly influenced by patterns of care. Thus, the target for future research involves analyzing how to improve outcomes, lower costs, and therefore maximize value.
Learn more about pediatric abdominal pain at Children's Mercy
Craig Friesen, MD, Medical Director, Abdominal Pain Program
For consults, admissions or transport call: 1 (800) GO MERCY / 1 (800) 466-3729.
1. Livitz M, Friesen AS, Glynn EF, Schurman JV, Colombo JM, Friesen CA. Healthcare system-to-system cost variability in the care of pediatric abdominal pain-associated functional gastrointestinal disorders. Children (Basel). 2021;8(11):985. Published 2021 Nov 1. doi:10.3390/children8110985
2. Friesen AS, Livitz M, Glynn EF, Schurman JV, Colombo JM, Friesen CA. High rate of emergency department care in youth with abdominal pain–associated functional gastrointestinal disorders. Pediatr Emerg Care. Published online January 27, 2022. doi:10.1097/PEC.0000000000002647
Children’s Mercy Kansas City is an independent, non-profit, 390-bed pediatric health system, providing over half a million patient encounters each year for children from across the country. Children’s Mercy is ranked by U.S. News & World Report in all ten specialties. We have received Magnet® recognition five times for excellence in nursing services. In affiliation with the University of Missouri-Kansas City, our faculty of nearly 800 pediatric specialists and researchers is actively involved in clinical care, pediatric research and educating the next generation of pediatricians and pediatric subspecialists. The Children’s Mercy Research Institute (CMRI) integrates research and clinical care with nationally recognized expertise in genomic medicine, precision therapeutics, population health, health care innovation and emerging infections. In 2021 the CMRI moved into a nine-story, 375,000-square-foot space emphasizing a translational approach to research in which clinicians and researchers work together to accelerate the pace of discovery that enhances care.