Cost of ambulatory care for the pediatric intestinal failure patient: One-year follow-up after primary discharge
Cost of ambulatory care for the pediatric intestinal failure patient: One-year follow-up after primary discharge
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DOI：
10.1016/j.jpedsurg.2016.02.026
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发表时间：
2016-05-01
影响因子：
2.4
通讯作者：
Wales, Paul W.
中科院分区：
文献类型：
--
作者：
Kosar, Christina;Steinberg, Karen;Wales, Paul W.
背景：在过去十年中，肠道衰竭儿童的生存率有所提高，导致医疗保健支出增加。我们的目的是确定初次出院后第一年的门诊费用。方法：回顾性分析2010 - 2012年儿科肠衰竭（PIF）患者。将患者分为3组（1 =无装置肠内支持[7例]，2 =有装置肠内支持（胃造口术和/或造口术）[19例]，3 =家庭肠外营养（HPN）[22例]）。数据提取包括临床特征和与用药、肠内/肠外营养相关的费用，并计算供应。数据分析采用单因素方差分析。结果：共纳入48例患者，平均年龄7.6个月，男性31例（65%）。结果见附表。HPN患者的门诊次数（p < 0.0001）、住院天数（p = 0.01）和生产天数损失（p < 0.0001）显著增加。与其他组相比，HPN患者的总护理费用明显更高（平均= 320,368.50美元，p < 0.0001）。采用HPN的患者的医疗保健系统支付的费用明显更高（平均= 316,101.56美元，p < 0.0001）。结论：PIF患者初次出院后第一年的门诊费用显著。我们的单一付款人医疗保健系统承担了大部分费用，但家庭也承担了与旅行和生产力损失有关的费用。接受HPN的儿童去医院的次数更多，但有更多的资金选择。然而，单纯接受胃造口术或造口治疗的儿童，其个人经济负担要大得多。(C) 2016 Elsevier Inc.版权所有。
Background: Survival of children with intestinal failure has improved over the last decade, resulting in increased health care expenditures. Our objective was to determine outpatient costs for the first year after primary discharge.Methods: A retrospective analysis was performed in pediatric intestinal failure (PIF) patients between 2010 and 2012. Patients were stratified into 3 groups (1 = enteral support with no devices [7 patients], 2 = enteral support with devices (gastrostomy and/or ostomy) [19 patients], 3 = home parenteral nutrition (HPN) [22 patients]). Data abstraction included clinical characteristics and costs related to medication, enteral/parenteral nutrition, and supplies were calculated. Data were analyzed using one way ANOVA.Results: Forty-eight patients (mean age 7.6months; 31 males [65%]) were studied. See attached table for results. HPN patients had significantly more ambulatory visits (p < 0.0001), number of admitted days (p = 0.01), and productive days lost (p < 0.0001). Total cost of care was significantly higher for HPN patients (mean = $320,368.50, p < 0.0001) when compared to other groups. Costs covered by the health care system were significantly higher for patients on HPN (mean = $316,101.56, p < 0.0001).Conclusion: The outpatient expenditures to care for PIF patients in the first year post primary discharge are significant. Our single payer health care system supports the majority of costs, but families are also incurring expenses related to travel and lost productivity. Children on HPN have more visits to hospital, but have access to more funding options. Children solely on gastrostomy or stoma therapy, however, have a significantly greater personal financial burden. (C) 2016 Elsevier Inc. All rights reserved.