Supply and Utilization of Pediatric Subspecialists in the United States
Supply and Utilization of Pediatric Subspecialists in the United States
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DOI：
10.1542/peds.2013-3466
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发表时间：
2014-06-01
期刊：
影响因子：
8
通讯作者：
Mehrotra, Ateev
中科院分区：
文献类型：
--
作者：
Ray, Kristin N.;Bogen, Debra L.;Mehrotra, Ateev
目的：美国儿科专科供应的广泛地理差异一直是一个令人担忧的问题。供应量减少地区的儿童是否得到的专科护理较少或结果更差还没有得到充分评估。在有特殊卫生保健需求的儿童中，我们调查了儿科专科供应与专科利用、需求、儿童疾病负担和家庭疾病负担的关系。方法：我们测量每个居住县的儿科专科医生人均供应。结果：县级儿科专科供应量的中位数为0(最低五分位数)至59(最高五分位数)/10万儿童。在调整后的结果中，与最高五分之一的儿童相比，供应最低五分之一的儿童报告门诊专科就诊的可能性低4.8%(P<；.001)，感知专科护理需求的可能性低5.3%(P<；.001)，报告急诊科就诊的可能性高2.3%(P<；.018)。儿科专科医生在儿童或家庭疾病负担的其他指标上的五分位数之间没有显著差异。结论：居住在儿科专科医生供应最少的县的儿童对专科医生的需求感知减少，对专科医生的利用也减少。然而，供应的差异与儿童或家庭疾病负担的显著差异无关。
OBJECTIVE: The wide geographic variation in pediatric subspecialty supply in the United States has been a source of concern. Whether children in areas with decreased supply receive less subspecialty care or have worse outcomes has not been adequately evaluated. Among children with special health care needs, we examined the association between pediatric subspecialty supply and subspecialty utilization, need, child disease burden, and family disease burden.METHODS: We measured pediatric subspecialist supply as pediatric subspecialists per capita in each residential county. By using the 2009-2010 National Survey of Children With Special Health Care Needs and controlling for many potential confounders, we examined the association between quintile of pediatric subspecialty supply and parent-reported subspecialty utilization, perceived subspecialty need, and child and family disease burden.RESULTS: County-level pediatric subspecialty supply ranged from a median of 0 (lowest quintile) to 59 (highest quintile) per 100 000 children. In adjusted results, compared with children in the highest quintile, children in the lowest quintile of supply were 4.8% less likely to report ambulatory subspecialty visits (P < .001), 5.3% less likely to perceive subspecialty care needs (P < .001), and 2.3% more likely to report emergency department visits (P < .018). There were no meaningful differences between pediatric subspecialty supply quintiles for other measures of child or family disease burden.CONCLUSIONS: Children living in counties with the lowest supply of pediatric subspecialists had both decreased perceived need for subspecialty care and decreased utilization of subspecialists. However, the differences in supply were not associated with meaningful differences in child or family disease burden.