Patterns and Costs of Health Care Use of Children With Medical Complexity
Patterns and Costs of Health Care Use of Children With Medical Complexity
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DOI：
10.1542/peds.2012-0175
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发表时间：
2012-12-01
期刊：
影响因子：
8
通讯作者：
Guttmann, Astrid
中科院分区：
文献类型：
--
作者：
Cohen, Eyal;Berry, Jay G.;Guttmann, Astrid
背景和目的：对于患有医疗复杂性（CMC）的儿童（例如患有神经功能障碍或其他复杂慢性病（CCC）的儿童以及需要技术援助（TA）的儿童）的医疗保健使用情况尚不清楚。本研究的目的是评估加拿大安大略省基于人口的 CMC 样本的医疗保健利用率和成本。方法：2005 年至 2007 年的出院数据确定了 CMC。对随后 2 年期间完整的卫生系统使用情况和成本进行了分析。 结果：该研究确定了 15 771 名住院 CMC（占安大略省儿童的 0.67%）； 10 340 例（65.6%）患有单器官 CCC，1063 例（6.7%）多器官 CCC，4368 例（27.6%）神经功能障碍，1863 例（11.8%）患有 TA。 CMC 平均有 13 名门诊医生和 6 名不同的专科医生。百分之三十六接受家庭护理服务。 30 天的再入院率从 12.6%（单次 CCC，无 TA）到 23.7%（多发 CCC，有 TA）不等。 CMC 几乎占儿童保健支出的三分之一。再住院费用占后续费用的最大比例（27.2%），其次是家庭护理（11.3%）和医生服务（6.0%）。家庭护理费用在 TA 儿童的费用中所占比例要大得多。患有多发性 CCC 且接受 TA 的儿童的费用比患有单一 CCC 且未接受 TA 的儿童高出 3.5 倍。结论：尽管 CMC 只占人口比例很小，但其在医疗保健费用中却占了相当大的比例。 CMC 在提供者和护理机构之间进行多次过渡，并且 CMC 与 TA 的成本和家庭护理使用率更高。改善他们的健康结果和降低成本的举措需要关注整个护理过程。儿科 2012；130：e1463-e1470
BACKGROUND AND OBJECTIVE: Health care use of children with medical complexity (CMC), such as those with neurologic impairment or other complex chronic conditions (CCCs) and those with technology assistance (TA), is not well understood. The objective of the study was to evaluate health care utilization and costs in a population-based sample of CMC in Ontario, Canada.METHODS: Hospital discharge data from 2005 through 2007 identified CMC. Complete health system use and costs were analyzed over the subsequent 2-year period.RESULTS: The study identified 15 771 hospitalized CMC (0.67% of children in Ontario); 10 340 (65.6%) had single-organ CCC, 1063 (6.7%) multiorgan CCC, 4368 (27.6%) neurologic impairment, and 1863 (11.8%) had TA. CMC saw a median of 13 outpatient physicians and 6 distinct subspecialists. Thirty-six percent received home care services. Thirty-day readmission varied from 12.6% (single CCC without TA) to 23.7% (multiple CCC with TA). CMC accounted for almost one-third of child health spending. Rehospitalization accounted for the largest proportion of subsequent costs (27.2%), followed by home care (11.3%) and physician services (6.0%). Home care costs were a much larger proportion of costs in children with TA. Children with multiple CCC with TA had costs 3.5 times higher than children with a single CCC without TA.CONCLUSIONS: Although a small proportion of the population, CMC account for a substantial proportion of health care costs. CMC make multiple transitions across providers and care settings and CMC with TA have higher costs and home care use. Initiatives to improve their health outcomes and decrease costs need to focus on the entire continuum of care. Pediatrics 2012;130:e1463-e1470