Who cares for Medicaid-enrolled children with chronic conditions?
Who cares for Medicaid-enrolled children with chronic conditions?
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DOI：
10.1542/peds.108.4.906
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发表时间：
2001-10-01
期刊：
影响因子：
8
通讯作者：
Perrin, JM
中科院分区：
文献类型：
--
作者：
Kuhlthau, K;Ferris, TGG;Perrin, JM
目标。评估加入医疗补助计划的慢性疾病儿童对全科医生、儿科专科医生和任何专科医生的使用情况，并确定使用的相关性。我们分析了1989年至1992年从4个州收集的57,328名患有11种慢性病的儿童和青少年的医疗补助申请数据。我们计算了全科医生、专科医生和儿科专科医生的年使用率。我们使用逻辑回归来确定人口统计学、城市居住和病例组合（调整临床组）与相关儿科和任何专科护理的使用之间的关系。在研究期间，大多数患有慢性疾病的儿童都去看了全科医生（每种疾病的范围：有补充安全收入的儿童为78%-90%，没有补充安全收入的儿童为85%-94%）。很少有儿童去看相关的专科医生（有SSI的儿童24%-59%，无SSI的儿童13%-56%）或相关的儿科专科医生（有SSI的儿童10%-53%，无SSI的儿童3%-37%）。一般来说，更有可能使用儿科专科医生的儿童年龄较小，居住在城市地区，是白人（仅对非ssi儿童有意义），并且具有更高的调整临床组得分。任何专科医生的使用都遵循类似的模式，除了城市居住仅在SSI儿童中具有统计学意义，而最小年龄组与最大年龄组没有SSI儿童的差异。结论。患有慢性疾病并加入医疗补助计划的儿童接受的大部分护理都是由全科医生提供的。在大多数情况下，大多数儿童在这一年中没有得到任何相关的亚专科护理，其中许多儿童没有得到受过儿科专门培训的提供者的护理。
Objective. To estimate generalist, pediatric subspecialist, and any subspecialist use by Medicaid-enrolled children with chronic conditions and to determine the correlates of use.Methods. We analyzed Medicaid claims data collected from 1989 to 1992 from 4 states for 57 328 children and adolescents with 11 chronic conditions. We calculated annual rates of generalist, subspecialist, and pediatric subspecialist use. We used logistic regression to determine the association of demographics, urban residence, and case-mix (Adjusted Clinical Groups) with the use of relevant pediatric and any subspecialist care.Results. Most children with chronic conditions had visits to generalists (range per condition: 78%-90% for children with Supplemental Security Income [SSI] and 85%-94% for children without SSI) during the year studied. Fewer children visited any relevant subspecialists (24%-59% for children with SSI and 13%-56% for children without SSI) or relevant pediatric subspecialists (10%-53% for children with SSI and 3%-37% for children without SSI). In general, children who were more likely to use pediatric subspecialists were younger, lived in urban areas, were white (only significant for non-SSI children), and had higher Adjusted Clinical Groups scores. Use of any subspecialists followed a similar pattern except that urban residence is statistically significant only for children with SSI and the youngest age group does not differ from the oldest age group for children without SSI.Conclusions. Children who had chronic conditions and were enrolled in Medicaid received a majority of their care from generalist physicians. For most conditions, a majority of children did not receive any relevant subspecialty care during the year and many of these children did not receive care form providers with pediatric-specific training.