Kansas Uses' Innovative Programs To Prevent Hospita&atioti Attheturnofthecentury,aKan- sas journalist, William Allen White, became nationally known for his editorial "What's the Matter with Kansas?" His theme was that "when anything is going to happen in this country, it happens first in Kansas." Although Kansas has had many "firsts" this century in public health and mental healthprogram- ming, home care ventilator de- pendent persons have not yet be- come reality. Kansas does have, however, a number of innovative out-of-hospital programsdesigned to prevent hospitalization in the first place or when necessary, to decrease the length of stay. This preventive approach offers a more normal life experience for the handicappedandtheirfamiliesand is cost effective as well. Some pro- files of programs follow. Cystic fibrosis program In 1966 the Kansas legislature appropriated funds to the Depart- ment of Health and Environment to develop services for all cysticfibro- sis children in the state. Since the appropriation was small, the de- partment designed an out-patient Program which lessened the need for hospitalization. Funds were earmarked for the provision of home inhalation equipment and medications at no cost to the families. Centralized purchasing resulted in considerable savings. Diagnostic and case management clinics were established in Wichita and Kansas City. A survey of parents three years after this program was begun, indicated that fewer hos- pitalizations were necessary and the family morale had been greatly improved. Currently, there are 239 active patients on the registrywith 30 over 21 years of age. Most CF chil- dren are progressing in school with their peer group and are becoming self-sufficient in early adulthood. In recent years, the Crippled and Chronically III Children's Program has paid for hospitalization for cys- ticfibrosis patientswhosefamilies are financially eligible. Third-party reimbursement has also strength- ened the financial base of the pro- gram in recent years. In one urban area, cystic fibrosis patients are being discharged from the hospital on intravenous therapy at home. This has decreased the average hospital stay from four weeks to one. Chronic obstructive pulmonary disease (COPD) The Kansas Lung Association in cooperation with physicians in urban and rural areas is en- couraging home based programs in which patients are taught 13 respiratory skills through indi- vidual or group instruction using a :self-study manual. A decreased need for hospitalization is an- tic ipated. Diabetes-outpatient manage- ment of the young diabetic patient The Kansas Medicaid program has had some positive experi- ences with theoutpatient manage- ment of severe diabetic children. One of their patients is a 14-year olcl girl who had been in a Wichita hospital for a total of eight months in a 12-month period including 32 days in intensive care, at a total cost to the agency of $59,000. Medicaid authorized the purchase of an expensive piece of equip- ment, an insulin pump, along with a ,glucometer for monitoring, her blood sugar, so that she could be discharged home. The child has remained homefor 18 monthswith no hospitalizations. The Medicaid agency has now authorized the purchase of additional insulin pumps for two other teenagers with equally good results. Dr. Richard Guthrie, Director of the history as follows. M.H. was born and Child Health Block Program. Kansas Regional Diabetic Center prematurely and weighed slightly lf the family had resided in a com- in Wichita, reports that there are over two pounds. His mother was munity with the special Maternity 64 persons currentlyon theinsulin 17 years old and had dropped out and Infant Care Program for teen- pump at home managed by this of the 10th grade with the preg- agers (there are 10 such programs center. He projects that the total nancy. She had received late and aCrOSS the state), this mother cost of the patient workup and inadequate prenatal care. The in- would have received improved pre- equipment and supplies for the fant was transferred to the inten- natalcareandtheWlCsupplemen- first year would be about $8,000 sive care unit at a Level 3 hospital tal food program with the likeli- compared to an average of sSO,OO0 in Kansas City by ambulance for hood of preventing the birth of a per year for repeated hospitafiza- management of the prematurity premature infant. Since the cost of tions. With 64 patients a year, the and. associated respiratory prob- this preventive health service for difference between home cost and terns. He remained in care for 24 mother and infants averages hospital cost is $1,3OO,OOO. If we days and was returned to a Level 2 $2,000, a cost savings for this pa- project this figure nationally, such hospital in his homecommunityfor tient would be $48,000. a program could save $50 million 14 days of convalescent care. The In summary, 1 would echo per year. cost of this hospital care was William Allen White and say, Prevention of prematurity programs $50,000. This infant is developing `There's nothing the matter with normally and special education Kansas" as Kansas responds with costs have been avoided by the practical approaches for home The cost of premature care excellent perinatal network pro- based programs to meet the needs can best be illustrated by a case gram established by the Maternal of families. 0