Incremental cost analysis of pediatric hospice care in rural and urban Appalachia.
Incremental cost analysis of pediatric hospice care in rural and urban Appalachia.
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阿巴拉契亚农村和城市儿科临终关怀的增量成本分析。
DOI：
10.1111/jrh.12713
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Lindley,LisaC
中科院分区：
文献类型：
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作者：
Svynarenko,Radion;Cozad,MelanieJ;Keim-Malpass,Jessica;Lindley,LisaC
目的考虑到阿巴拉契亚地区城乡之间健康结果的日益扩大的差异，本研究比较了儿科同时护理(由患者保护和平价医疗法案实施)和标准临终关怀的医疗补助增量成本。方法从医疗保险和医疗补助服务中心获得2011年至2013年期间从阿巴拉契亚地区收集的1788名儿童临终关怀患者的数据。采用多水平广义线性模型分析同期临终关怀与标准临终关怀登记的每月每名患者(PPM)增量成本。分析的增量为临终关怀住院时间(LOS)。结果在同时接受临终关怀的农村儿童中，临终关怀的平均医疗补助成本为3954PPPM(95%CI：3,223-4684)，而城市儿童的平均医疗补助成本为1933 PPPM(95%CI：1,357-2,509)。对于登记参加标准临终关怀的农村儿童，平均医疗补助成本为2889 PPPM(95%CI：2,639-3,139)，而城市儿童的平均医疗补助成本为1,122 PPPM(95%CI：980-1,264)。在LOS的1天内，医疗补助费用在统计学上没有显著差异。然而，对于2到14天的concurrentcarehadhighercostscomparedtostandardcare，，同时入学降低了城市儿童的总费用(IC=1,172‐2,363).ConclusionsThefindingsrevealedthatMedicaidcostsforconcurrenthospicecarewerehighestamongchildreninruralAppalachia.Futureresearchonfactorsofhighcostsofruralcareisneeded.236.9PPPM，95%CI：−421-−53)。在15天或更长的时间里，农村儿童(IC=1,399 PPPM，95%CI：92-2,706)和城市儿童(IC=1,867 PPPM，95%CI：−)的LOS
Purpose Considering growing disparities in health outcomes between rural and urban areas of Appalachia, this study compared the incremental Medicaid costs of pediatric concurrent care (implemented by the Patient Protection and Affordable Care Act) versus standard hospice care. Methods Data on 1,788 pediatric hospice patients, from the Appalachian region, collected between 2011 and 2013, were obtained from the Centers for Medicare and Medicaid Services. Incremental per‐patient‐per‐month (PPM) costs of enrollment in concurrent versus standard hospice care were analyzed using multilevel generalized linear models. Increments for analysis were hospice length of stay (LOS). Results For rural children enrolled in concurrent hospice care, the mean Medicaid cost of hospice care was 3,954PPPM(95%CI: 3,223‐4,684)versus 1,933 PPPM (95% CI: 1,357‐ 2,509) for urban. For rural children enrolled in standard hospice care, the mean Medicaid cost was 2,889PPPM(95%CI: 2,639‐3,139)versus 1,122 PPPM (95% CI: 980‐ 1,264) for urban. There were no statistically significant differences in Medicaid costs for LOS of 1 day. However, for LOS between 2 and 14 days, concurrent enrollment decreased total costs for urban children (IC= −236.9PPPM,95%CI:− 421‐−53).ForLOSof15daysormore,concurrentcarehadhighercostscomparedtostandardcare,forbothrural(IC= 1,399 PPPM, 95% CI: 92‐ 2,706) and urban children (IC= 1,867PPPM,95%CI: 1,172‐2,363).ConclusionsThefindingsrevealedthatMedicaidcostsforconcurrenthospicecarewerehighestamongchildreninruralAppalachia.Futureresearchonfactorsofhighcostsofruralcareisneeded.