1. Feasible Restructuring For Treatment of Bronchiopulmonary Dysplasia (BPD)
For
MedArts
By
Kevin Davison
Technical Writer
Quevin, LLC
March 2008

2. INTRODUCTION
There is no immediate solution to cure BPD and MedArts has the ethical responsibility to
continue to provide its quality treatment of BPD with proper medical equipment, and certified
medical professionals in its NBICU’s. Mortality rates have not changed since the application of
experimental treatments, and the need for specialized care of BPD patients in MedArts newborn
intensive care units (NBICU) is proven to be necessary. Surfactant replacement therapy (SRT)
was hoped to eliminate BPD. However, chronic lung disease continues to develop in a significant
number of premature infants. According to the National Heart, Lung, and Blood Institute
(NHLBI) of the National Institutes of Health (NIH), between 5,000 and 10,000 cases of BPD
occur every year in the United States. Preliminary tests reveal which infants are most at risk, and
the complications related to BPD can compound fatality.
This study evaluates the advantages and disadvantages of each feasible option based on
providing BPD patients quality, cost-effective health care. This must be financially feasible for
MedArts, and convenient enough for families involved to travel and feel close to their infants
suffering from BPD. Hundreds of families and dozens of doctors were interviewed for this study.
NelsonNygard, a Transportaion Planning Agency, was also contracted to supply transportation
and geographic analysis for this evaluation. The feasible options are to remain in the status quo,
decentralize the care of BPD, or centralize entirely at Longworth Pediatric Hospital (LPH).
LPH is staffed with four certified pediatric pulmonologists or pediatric cardiologists. Although
each MedArts hospital has adequate equipment and staffing to treat BPD, Fairfax Medical Center
and Rivershore District Regional Hospital rely entirely on LPH for specialized care. Is the status
quo still a financially viable way to provide quality treatment of BPD patients and their families?
LPH is already providing adequate care, therefore, it may be more viable to centralize the care of
BPD with less emphasis on Fairfax and Rivershore. This alleviates resources so LPH may
continue providing the level of care it does. However, all hospitals do have adequate resources to
treat BPD. It may be less of a financial burden to decentralize the approach of treating BPD, and
spread resources equally between LPH, Farifax and Rivershore. The priority to consider is
whether the provision of quality care is sustainable with either of these options.
How Does MedArts Continue To Provide The Best Quality Healthcare?
The AAFP defines quality healthcare as “the achievement of optimal physical and mental health
through accessible, cost-effective care that is based on best evidence, is responsive to the needs
and preferences of patients and populations, and is respectful of patients’ families, personal
values and beliefs.” MedArts is committed to providing patients quality, cost-effective health
care. The highest priority is to provide the best and most responsive treatment, as ethically as
possible.
All hospitals have the equipment and medical staffing necessary to treat BPD, considering the
status quo. However, certified pediatric pulmonologists reside at LPH and are in contact with
neonatologists and pediatricians at Farirfax and Rivershore only by phone. Although all hospitals
monitor closely for infection, LPH is the only one that has pediatric infectious disease specialists.
This service disparity between the level of BPD care offered at LPH and other hospitals may
degrade the overall quality of care that MedArts can provide. LPH is the only hospital prepared
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3. to treat all BPD complications. LPH is also the only hospital that has Extracorporeal Membrane
Oxygenation (ECMO) capabilities and pediatric pulmonology. The time it takes to transport
patients from other hospitals to LPH may result in the depletion of the quality care MedArts is
committed to, and the overall safety of its patients.
Nelson Nygard revealed that transportation delay and mobile treatment accessibility is a concern
when considering centralization at LPH. The crucial moments between diagnosis and
stabilization could cost the life of a patient, especially if there is mechanical failure during
transport or traffic congestion. This may require frequent helicopter usage, which can increase
costs. There will be better care available to the child if BPD results after a child is delivered at
birth or brought directly to LPH. Unfortunately, if a child is delivered prematurely at Longworth
or Fairfax and complications escalate to BPD. Children experience some risk or further
complications without the specialized care available at LPH. Remote consultation by LPH may
not be enough to match the level of care for Fairfax and Rivershore.
Decentralization will offer more immediate care for patents in all three MedArts hospitals,
without discrimination of BPD care. No single hospital will provide the highest care, and will be
spread-out amongst the MedArts system. However, will this spread-thin the care that one
specialized hospital could provide better? LPH already has the best care available to treat BPD.
The certified pulmonologists may not want to relocate or commute to Fairfax or Rivershore.
LPH presently has its how BPD unit, aside from the NBICU, so the other hospitals will either
need to match this construction or utilize other space. The costs of construction may cost
millions.
How Do The Financial Considerations Compare?
While MedArts is dedicated to providing the best, quality healthcare, it is also important that the
MedArts system can continue to offer quality treatment consistently, and as cost-effectively as
possible. Some of the main cost considerations are mechanical equipment, emergency and
medical transportation, medical staffing and providing family support for victims of BPD.
It is still possible to continue to offer the level of quality healthcare with the status quo. Certified
pulmonologists reside only at LPH and traveling wastes their time, which is costly. Nelson
Nygard quantified that it could cost MedArts $100,000 per month in transportation costs and loss
of doctor availability. However, interactive video confrencing technology may be available to
solve this problem, and would range between $2,000 and $15,000. It depends on the number of
units, and would still be a fraction of the costs calculated by Nelson Nygard’s findings. Video
conferencing and remote manipulation of NBICU equipment may be possible with further
evaluation of these services.
LPH is the primary recipient of donations from various organizations to help families pay for
treatment, which is one consideration for centralization to LPH, Fairfax and Rivershore do not
presently have this kind of dedicated financial support for families. It may therefore be to the
family’s advantage to request transfer to LPH, ultimately resulting in a more centralized result
anyway. Pulmonologists are presently staffed at LPH, and the hospital has its own BPD unit, as
well as an NBICU. However, the capacity of this hospital may not be sufficient to hold the
increase of patients presently represented at Fairfax and Rivershore. There may need to be
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4. construction to accommodate the extra patients. While LPH is presently capable of providing
multispecialty consultation, it may not be able to provide the same level of care to all patients
with BPD in the MedArts system with the increased volume.
The equipment used to treat BPD at Fairfax and Rivershore may be utilized at LPH, and possibly
sold to finance increased needs from centralization at LPH. There will be more transportation
costs to consider between hospitals for families who initially had their child at Fairfax or
Rivershore, only to be taken to LPH. There is not only the patient emergency transportation to
consider, but also the patient’s families, especially if they don’t have their own transportation.
MedArts cares for the families of its patients, and wants to accommodate their need to be with
the patient.
As with the status quo, decentralization wouldn’t alter equipment and staffing, except for LPH.
However, there may not be enough certified pulmonologits willing to staff Fairfax and
Longworth. It also costs time and money to transfer doctors between locations The realized cost
to transfer doctors between hospitals is clear, and the next consideration is how transportation
requirements effect families with infants being treated with BPD throughout the MedArts
system.
How Do Transportation Alterations Affect Patient’s Famililies?
Parents and family members with infants suffering from BPD must also be accommodated so
they can spend time comfortably with them. Each option has evaluated how doctors and patients
will be affected. The options should evaluate how families will affected too.
Of the hundreds of families interviewed for this study, 80% say they have had no trouble with
transportation as-is, with the status quo. However, 15% were either incapable of traveling
regularly to visit the hospital, or had special needs that required timely accommodation. For
instance, one mother was confined to a wheelchair after the pregnancy, and didn’t have a way to
get to the hospital without considerable effort.
Considering centralization, most families interviewed throughout the region may not have
adequate transportation to visit LPH regularly enough. Most families interviewed considered the
status quo to be best suited to their needs. However, 90% agreed that quality care for infants with
BPD is a higher priority. Therefore, they didn’t think transportation difficulty would alter their
perspectives on the quality of care that MedArts would provide, as long as the infants with BPD
are treated best.
If MedArts decentralizes, LPH may need to provide more facilities for visiting family members,
including transportation between other hospitals. Families will require improved access to their
child, due to prolonged treatment of BPD at each location. If the quality of care can be
maintained consistently throughout all MedArts locations, then families may feel more secure
about the care of their infant. If pulmonologists are willing to relocate or commute to their new
assigned locations, this will provide specialized care at all locations. However, will this dilute the
care that is presently being provided at LPH by four in collaboration?
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5. CONCLUSIONS
The table below compares feasible options considered in this study, based on the quality of
healthcare, financial, and transportation criteria.
Status quo Centralization Decentralization
Quality of Healthcare X
Financial X
Transportation X
Under the status quo, patients suffering from BPD have a better chance of survival at LPH if
their situation requires multispecialty consultation or more intensive ECMO for treatment.
However, most treatment provided by all hospitals in the MedArts system do have adequate
staffing and capabilities to treat most cases of BPD in their NBICU’s. Transportation for patients
and remote consultation doesn’t seem to be a problem. All hospitals have adequate systems to
transport patients if necessary.
Centralization provides a consolidated approach to the treatment of BPD at LPH. LPH has more
than adequate staffing with certified pediatric pulmonologists and advanced systems like ECMO
to treat the worst cases of BPD. The geographic location requires more consideration for
transportation from Fairfax and Rivershore, and may require the use of a helicopter for cases that
are too risky for ground transportation. Unfortunately, LPH may not have adequate space to
provide immediately for centralization. Expansion may be required, which has financial
implications, as well as disruption of service problems.
Decentralization primarily accommodates the transportation of patients to one of the three
locations in the MedArts system. Families have improved access to each location, and there
would be less risk due to moving patients in need of treatment at another facility. However, this
also requires that each location add their own BPD unit, ECMO, and certified pulmonologists on
staff to treat even the worst cases. Financially, this is the most expensive option to consider.
POSSIBLE NEXT STEPS
It would be useful to estimate the costs associated with each option to qualify whether either
option is viable. Decentralization and the Status quo have the greatest costs related to equipment
and staffing at Fairfax and Rivershore. LPH might have the staffing and equipment, but not the
adequate space for a centralized approach. These construction costs could be estimated. It may
also be helpful to hire a transportation planner to coordinate emergency routes between hospitals
for the centralized option, since MedArts already knows this for status quo and a decentralized
approach. Finally, it would be useful to survey the parents of existing BPD patient’s parents
throughout the MedArts system about their transportation needs and how each option would
affect them personally.
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