Wishes help keep pediatric patients out of the hospital

November 13, 2018, Nationwide Children's Hospital

Cimone Stills, 15, has a medical condition that has caused her to have multiple seizures a day for most of her life. Specifically, she has treatment-resistant generalized epilepsy because of a genetic variation. Like many patients with such a serious illness, it affects her daily life and as a result, she was diagnosed with clinical depression. But Cimone's outlook on life completely changed for the better after her wish of going to Paris. Cimone says that the wish helped provide her perspective and hope. It also helped reduced her number of seizures over time.

As a member of the Medical Advisory Council of Make-A-Wish America, Anup Patel, MD, section chief of Neurology at Nationwide Children's Hospital, anecdotally could attest that wishes like Cimone's positively affected the patients he saw in the Complex Epilepsy Clinic at Nationwide Children's. As a clinician, he sought evidence to support his hypothesis that these experiences provided children with progressive, life-threatening, or critical illnesses more than hope—that in fact, they had a clinical benefit.

Whatever a child has wished for—a puppy, seeing snow for the first time or to meet their favorite celebrity—a recent study led by Nationwide Children's demonstrates that experiences, or "wishes," granted to pediatric patients can actually reduce health care utilization. In the retrospective study published online by Pediatric Research, patients granted a wish were 2.5 times more likely to have fewer unplanned admissions and 1.9 times more likely not to have to use the emergency department. This led to a decline in cost of care even after accounting for the average cost of the wish.

"My patients have about a one to three percent chance of ever becoming seizure-free. Not every patient of mine who gets a wish is going to come back seizure-free, but they are going to improve," said Dr. Patel. "Their quality of life is going to be better and that might have an indirect impact on their seizures. They may have fewer seizures as a result, or be more likely to take their medications. Moreover, we are able to give them something they would not otherwise get: a break from their illness."

"My wish that was granted in 1988 changed the way I felt about my illness, and it motivated me to fight even harder, to believe even more that there was a future for me," said Tiffany Rowe, Make-A-Wish recipient and chair of the Make-A-Wish National Board Alumni Association. "It is fundamentally part of why I am still here today."

The study compared patients who received or did not receive a wish and associated impact on healthcare utilization and costs across two years. From 2011 to 2016, 496 Nationwide Children's Hospital patients received a wish. These were matched to the same number of a control group based on age, gender, disease category and disease complexity.

"Wishes are a nice thing to do for a patient, their family and siblings, but for the first time this study lets us say that a wish is more than just nice," said Dr. Patel. "A wish is something that potentially can help the health of a child get better over time, impact healthcare utilization and reduce dollars spent on healthcare."

Dr. Patel says larger populations of wish-receiving need to be studied to determine if this pilot study can be replicated, and to help researchers understand why wishes have such a positive impact.

Explore further: QI initiative cuts health care use in children with epilepsy

More information: Anup D. Patel et al, Impact of a Make-A-Wish experience on healthcare utilization, Pediatric Research (2018). DOI: 10.1038/s41390-018-0207-5

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