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Text
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Citation List Month
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URL Address
<a href="http://doi.org/10.1542/peds.2004-2084" target="_blank" rel="noreferrer">http://doi.org/10.1542/peds.2004-2084</a>
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Title
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Utilization and costs for children who have special health care needs and are enrolled in a hospital-based comprehensive primary care clinic
Publisher
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Pediatrics
Date
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2005
Subject
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Child; Female; Humans; infant; Male; Cohort Studies; Inpatients; Hospitals; Health Expenditures; Colorado; adolescent; Preschool; Outpatient Clinics; infant; Costs and Cost Analysis; Newborn; Hospitalization/statistics & numerical data; Outpatients; disabled children; Specialties; Laboratories; Hospital/economics/utilization; Exceptional; Health Maintenance Organizations/economics/utilization; Health Resources/statistics & numerical data; Health Services Needs and Demand/economics; Hospital Costs; Hospital Departments/economics/utilization; Medicaid/economics/utilization; Medical/economics; Needs Assessment/economics; Pediatric/economics/organization & administration; Primary Health Care/economics/utilization
Creator
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Berman S; Rannie M; Moore L; Elias E; Dryer LJ; Jones MD
Description
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OBJECTIVE: When deciding how much hospital resources should be allocated to comprehensive primary care clinics for children with multisystem disorders, it is important to consider all of the non-primary care revenue streams associated with these children as well as the effects of a comprehensive primary care program on access and quality. The objectives of this study were, first, to determine costs as well as the payments associated with hospital ambulatory and inpatient services for children with multisystem disorders followed by a comprehensive primary care clinic; and, second, to determine the effect of enrollment in a hospital-based comprehensive primary care clinic on ambulatory and inpatient utilization patterns and expenditures for children with multisystem disorders. METHODS: The study population for the payment analysis consisted of 1012 children of all ages who were seen in the Special Primary Care Clinic (SPCC) in 2001. For these children, outcomes included direct costs, total (direct plus allocated overhead) costs, and payments per patient per 365 days after their first SPCC visit in 2001. A total of 175 of these patients were 4 years of age or older and had no SPCC visit before their first visit in 2001. We compared utilization and expenditures for the 175 children during the year before enrollment in SPCC with those in the year after enrollment. The Children's Hospital administrative database was used to document direct costs, total costs, and payments by type of service for 365 days after an index visit. Ambulatory services included medical and surgical ambulatory, inpatient, emergency department (ED), and ancillary services. We determined the proportion of children who had visits; the visit rates per 100 child-years; and the average total and direct costs per visit, per child with a visit, and per child-year. Inpatient services data included non-intensive care and intensive care hospitalization rates per 100 child-years; the proportion of children hospitalized; their average length of stay; and the average total and direct costs per hospitalization, per patient hospitalized, and per child-year of total patients in the cohort. RESULTS: For 1012 children who were seen in SPCC in 2001, the hospital overall loss per child-year was $956. The loss per child-year for outpatient services was $1554. This loss was partially offset by a gain from inpatient services of $598. For the 175 patients for whom data were available to compare costs before and after enrollment in the SPCC, there were no significant differences in hospitalization or in direct costs per patient for patients who were hospitalized. The average length of non-intensive care stay was lower after enrollment (4.8 vs 11.7). In the surgical specialty analysis, children were more likely to see a surgeon after enrollment (41% vs 21%) and had a higher rate of visits per 100 child-years (102.3 vs 51.4). Differences in medical subspecialty, ancillary, and ED services did not achieve statistical significance. CONCLUSION: This study suggests that children with multisystem disorders are medically fragile and require frequent hospitalizations and ED visits even with improved primary care. Enrollment in a comprehensive primary care program was associated with a decreased length of stay for non-intensive care hospitalizations and with increased use of surgical services.
2005
Identifier
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<a href="http://doi.org/10.1542/peds.2004-2084" target="_blank" rel="noreferrer">10.1542/peds.2004-2084</a>
Rights
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2005
Adolescent
Backlog
Berman S
Child
Cohort Studies
Colorado
Costs And Cost Analysis
Disabled Children
Dryer LJ
Elias E
Exceptional
Female
Health Expenditures
Health Maintenance Organizations/economics/utilization
Health Resources/statistics & numerical data
Health Services Needs and Demand/economics
Hospital Costs
Hospital Departments/economics/utilization
Hospital/economics/utilization
Hospitalization/statistics & numerical data
Hospitals
Humans
Infant
Inpatients
Jones MD
Journal Article
Laboratories
Male
Medicaid/economics/utilization
Medical/economics
Moore L
Needs Assessment/economics
Newborn
Outpatient Clinics
Outpatients
Pediatric/economics/organization & administration
Pediatrics
Preschool
Primary Health Care/economics/utilization
Rannie M
Specialties