Chronic Medication Burden After Cardiac Surgery for Pediatric Medicaid Beneficiaries.
Chronic Medication Burden After Cardiac Surgery for Pediatric Medicaid Beneficiaries.
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儿科医疗补助受益人心脏手术后的慢性药物负担。
DOI：
10.1016/j.jacc.2023.06.046
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发表时间：
2023
影响因子：
24
通讯作者：
De
中科院分区：
文献类型：
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作者：
Woo,JoyceL;Nash,KatherineA;Dragan,Kacie;Crook,Sarah;Neidell,Matthew;Cook,Stephen;Hannan,EdwardL;Jacobs,Marshall;Goldstone,AndrewB;Petit,ChristopherJ;Vincent,Robert;Walsh-Spoonhower,Kathleen;Mosca,Ralph;Kumar,TKSusheel;De
研究背景先天性心脏病是最常见、资源密集型的出生缺陷。随着先天性心脏病患儿的存活率越来越高，了解其纵向疾病负担已势在必行。ObjectivesThe purpose of this study was to examine chronic outpatient prescription medications use and expenditures for纽约州儿科医疗补助登记者，比较接受心脏手术的儿童方法这是一项回顾性队列研究，所有年龄<使用纽约州先天性心脏手术纵向结局和资源利用协作数据库（2006-2019）的18年。主要结局是每人年的慢性药物总使用量、每100人年使用≥1种和≥3种药物的入组人数以及每人年的药物支出。我们描述并比较了心脏病患者和普通儿科人群的结局。在心脏登记，多变量回归研究之间的关联结果和临床characteristics.ResultsWe包括5,459独特的儿童（32,131人年）谁接受了心脏手术和450万儿童（2200万人年）谁没有。接受心脏手术的儿童中有超过4/10的儿童使用≥1种慢性药物，而未接受心脏手术的儿童中约有1/10使用。与非心源性入组者相比，心源性入组者每人每年的药物支出高出10倍。在心脏登记者中，疾病严重程度与慢性药物使用相关;婴儿使用率最高;然而，近一半的青少年使用≥1种慢性药物治疗。了解慢性药物使用可以告知临床医生（儿科医生和专科医生）和政策制定者，并最终为这个医学复杂人群提供护理的价值。
BackgroundCongenital heart defects are the most common and resource-intensive birth defects. As children with congenital heart defects increasingly survive beyond early childhood, it is imperative to understand longitudinal disease burden.ObjectivesThe purpose of this study was to examine chronic outpatient prescription medication use and expenditures for New York State pediatric Medicaid enrollees, comparing children who undergo cardiac surgery (cardiac enrollees) and the general pediatric population.MethodsThis was a retrospective cohort study of all Medicaid enrollees age <18 years using the New York State Congenital Heart Surgery Collaborative for Longitudinal Outcomes and Utilization of Resources database (2006-2019). Primary outcomes were total chronic medications per person-year, enrollees per 100 person-years using ≥1 and ≥3 medications, and medication expenditures per person-year. We described and compared outcomes between cardiac enrollees and the general pediatric population. Among cardiac enrollees, multivariable regression examined associations between outcomes and clinical characteristics.ResultsWe included 5,459 unique children (32,131 person-years) who underwent cardiac surgery and 4.5 million children (22 million person-years) who did not. More than 4 in 10 children who underwent cardiac surgery used ≥1 chronic medication compared with approximately 1 in 10 children who did not have cardiac surgery. Medication expenditures were 10 times higher per person-year for cardiac compared with noncardiac enrollees. Among cardiac enrollees, disease severity was associated with chronic medication use; use was highest among infants; however, nearly one-half of adolescents used ≥1 chronic medication.ConclusionsChildren who undergo cardiac surgery experience high medication burden that persists throughout childhood. Understanding chronic medication use can inform clinicians (both pediatricians and subspecialists) and policymakers, and ultimately the value of care for this medically complex population.