Specialist use among privately insured children with disabilities.
Specialist use among privately insured children with disabilities.
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私人保险残疾儿童的专业使用。
DOI：
10.1111/1475-6773.14199
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发表时间：
2023
影响因子：
3.4
通讯作者：
Landrum,MaryBeth
中科院分区：
文献类型：
--
作者：
Chien,AlynaT;Wisk,LaurenE;Beaulieu,Nancy;Houtrow,AmyJ;VanCleave,Jeanne;Fu,Christina;Cutler,David;Landrum,MaryBeth
Objectiveinvestigate primary care practice ownership and specialist‐use patterns for commercial insured children with disabilities.Data Sources and Study SettingA national commercial claims database and the Health Systems and Provider Database from 2012 to 2016 are data sources for this study.研究设计This cross-sectional，descriptive study examines：（1）访问量最大的儿科初级保健医生和实践类型（独立或系统所有）;（2）儿科和非儿科专家使用模式;以及（3）实践所有权与专家使用模式的关系。数据收集/提取方法本研究确定了133个，749人年的0- 10岁残疾儿童商业保险通过将国家商业索赔数据集与卫生系统和提供者数据库相连接，并应用经验证的残疾算法。主要发现四分之三（75.9%）的残疾儿童在独立的实践中接受儿科初级保健。近三分之二（59.6%）使用至少一名专家，45.1%使用非儿科专家，28.8%使用儿科专家，17.0%使用两者。专家使用模式因儿童年龄和专家类型而异。独立执业的残疾儿童与系统拥有的残疾儿童一样有可能去看专家：分别为57.1%（95%置信区间[95% CI] 56.7%-57.4%）和57.3%（95% CI 56.6%-58.0%）（p= 0.635）。在独立实践中，使用两种或多种类型的专家的百分比为46.1%（95%CI 45.4%-46.7%），与系统中的47.1%（95%CI 46.2%-48.0%）相当（p= 0.054）。然而，在这方面，独立诊所的专家平均就诊次数显著低于系统-4.0（95% CI 3.9%-4.0%）vs 4.4（95% CI 4.3%-4.6%）分别达到统计学显著性，p <0.0001.结论认识到私人保险的残疾儿童如何使用儿科和非儿科初级保健专家的儿科初级保健，独立和系统拥有的实践对于提高护理质量和价值都很重要。
ObjectiveTo investigate primary care practice ownership and specialist‐use patterns for commercially insured children with disabilities.Data Sources and Study SettingA national commercial claims database and the Health Systems and Provider Database from 2012 to 2016 are the data sources for this study.Study DesignThis cross‐sectional, descriptive study examines: (1) the most visited type of pediatric primary care physician and practice (independent or system‐owned); (2) pediatric and non‐pediatric specialist‐use patterns; and (3) how practice ownership relates to specialist‐use patterns.Data Collection/Extraction MethodsThis study identifies 133,749 person‐years of commercially insured children with disabilities aged 0–18 years with at least 24 months of continuous insurance coverage by linking a national commercial claims data set with the Health Systems and Provider Database and applying the validated Children with Disabilities Algorithm.Principal FindingsThree‐quarters (75.9%) of children with disabilities received their pediatric primary care in independent practices. Nearly two thirds (59.6%) used at least one specialist with 45.1% using nonpediatric specialists, 28.8% using pediatric ones, and 17.0% using both. Specialist‐use patterns varied by both child age and specialist type. Children with disabilities in independent practices were as likely to see a specialist as those in system‐owned ones: 57.1% (95% confidence interval [95% CI] 56.7%–57.4%) versus 57.3% (95% CI 56.6%–58.0%), respectively (p= 0.635). The percent using two or more types of specialists was 46.1% (95% CI 45.4%–46.7%) in independent practices, comparable to that in systems 47.1% (95% CI 46.2%–48.0%) (p= 0.054). However, the mean number of specialist visits was significantly lower in independent practices than in systems—4.0 (95% CI 3.9%–4.0%) versus 4.4 (95% CI 4.3%–4.6%) respectively—reaching statistical significance withp< 0.0001.ConclusionsRecognizing how privately insured children with disabilities use pediatric primary care from pediatric and nonpediatric primary care specialists through both independent and system‐owned practices is important for improving care quality and value.