Managed care organizational characteristics and health care use among children with special health care needs.
Managed care organizational characteristics and health care use among children with special health care needs.
复制标题
管理式护理组织特征和有特殊医疗保健需求的儿童的医疗保健使用。
DOI：
10.1111/j.1475-6773.2003.00195.x
复制
发表时间：
2003
影响因子：
3.4
通讯作者：
Sherman,James
中科院分区：
文献类型：
--
作者：
Shenkman,Elizabeth;Wu,SamuelS;Nackashi,John;Sherman,James
目的：探讨管理型医疗机构(MCO)的特征与儿童卫生保健利用模式之间的关系。数据来源：2223名有特殊医疗需求儿童的父母的电话调查数据、MCO管理者访谈数据和卫生保健索赔数据。研究设计：使用来自家庭的横断面调查数据，关于其子女状况的后果数量和MCO管理者关于其计划组织特征的横断面调查数据。利用数据约简技术建立了反映MCO特性的指标。研究人员开发了分层模型来检验儿童社会人口学和健康特征与MCO指数之间的关系：儿科医生关注(PF)指数、专科医生关注(SF)指数和服务费用(FFS)指数，以及门诊使用率和收费、住院、急诊室(ER)就诊和专科咨询。数据收集/提取方法：电话和MCO管理员调查数据与登记和索赔文件相关联。主要发现：儿童的年龄、性别和病情后果是与医疗保健使用和收费相关的一致预测变量。PF指数与门诊使用率和费用的减少以及住院人数的减少有关。SF指数与急诊室就诊次数增加和专科就诊次数减少相关，而FFS指数与门诊使用率和费用增加相关。结论：在控制了社会人口学和健康特征后，PF、SF和FFS指数与儿童卫生保健利用模式显著相关。
Objective.To examine the relationship between features of managed care organizations (MCOs) and health care use patterns by children.Data Sources.Telephone survey data from 2,223 parents of children with special health care needs, MCO‐administrator interview data, and health care claims data.Study Design.Cross‐sectional survey data from families about the number of consequences of their children's conditions and from MCO administrators about their plans' organizational features were used. Indices reflecting the MCO characteristics were developed using data reduction techniques. Hierarchical models were developed to examine the relationship between child sociodemographic and health characteristics and the MCO indices labeled: Pediatrician Focused (PF) Index, Specialist Focused (SF) Index, and Fee‐for‐Service (FFS) Index, and outpatient use rates and charges, inpatient admissions, emergency room (ER) visits, and specialty consultations.Data Collection/Extraction Methods.The telephone and MCO‐administrator survey data were linked to the enrollment and claims files.Principal Findings.The child's age, gender, and condition consequences were consistent predictor variables related to health care use and charges. The PF Index was associated with decreased outpatient use rates and charges and decreased inpatient admissions. The SF Index was associated with increased ER visits and decreased specialty consultations, while the FFS Index was associated with increased outpatient use rates and charges.Conclusion.After controlling for sociodemographic and health characteristics, the PF, SF, and FFS indices were significantly associated with children's health care use patterns.