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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Shared decision-making and health care expenditures among children with special health care needs.
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Shared decision-making and health care expenditures among children with special health care needs.

机译：在有特殊医疗保健需求的儿童之间共享决策和医疗保健支出。

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BACKGROUND AND OBJECTIVES: To understand the association between shared decision-making (SDM) and health care expenditures and use among children with special health care needs (CSHCN). METHODS: We identified CSHCN <18 years in the 2002-2006 Medical Expenditure Panel Survey by using the CSHCN Screener. Outcomes included health care expenditures (total, out-of-pocket, office-based, inpatient, emergency department [ED], and prescription) and utilization (hospitalization, ED and office visit, and prescription rates). The main exposure was the pattern of SDM over the 2 study years (increasing, decreasing, or unchanged high or low). We assessed the impact of these patterns on the change in expenditures and utilization over the 2 study years. RESULTS: Among 2858 subjects representing 12 million CSHCN, 15.9% had increasing, 15.2% decreasing, 51.9% unchanged high, and 17.0% unchanged low SDM. At baseline, mean per child total expenditures were Dollars 2131. Over the 2 study years, increasing SDM was associated with a decrease of Dollars 339 (95% confidence interval: Dollars 21, Dollars 660) in total health care costs. Rates of hospitalization and ED visits declined by 4.0 (0.1, 7.9) and 11.3 (4.3, 18.3) per 100 CSHCN, and office visits by 1.2 (0.3, 2.0) per child with increasing SDM. Relative to decreasing SDM, increasing SDM was associated with significantly lower total and out-of-pocket costs, and fewer office visits. CONCLUSIONS: We found that increasing SDM was associated with decreased utilization and expenditures for CSHCN. Prospective study is warranted to confirm if fostering SDM reduces the costs of caring for CSHCN for the health system and families.
机译：背景与目的：了解共有决策（SDM）与特殊保健需要儿童之间的医疗保健支出和使用之间的关联。方法：我们在2002-2006年医疗费用小组调查中使用CSHCN筛选器确定了CSHCN <18年。结果包括医疗保健支出（总支出，自付费用，办公室支出，住院病人，急诊室[ED]和处方）和使用率（住院，ED和办公室就诊以及处方率）。主要暴露是两个研究年中的SDM模式（增加，减少或保持不变的高低）。我们评估了这两种模式对两个研究年度内支出和利用率变化的影响。结果：在代表1200万CSHCN的2858名受试者中，SDM升高了15.9％，降低了15.2％，未改变的SDM升高了51.9％，未改变的SDM降低了17.0％。基线时，每个孩子的平均总支出为2131美元。在两个研究年度中，SDM的增加与总医疗保健成本的减少339美元（95％置信区间：21美元，660美元）相关。随着SDM的增加，每100个CSHCN的住院和急诊就诊率分别下降4.0（0.1，7.9）和11.3（4.3，18.3），每名儿童的办公室就诊率下降1.2（0.3，2.0）。相对于SDM的减少，SDM的增加与总和自付费用的显着降低以及上门拜访的次数减少有关。结论：我们发现SDM的增加与CSHCN的利用率和支出减少有关。有必要进行前瞻性研究，以确认培育SDM是否可以降低卫生系统和家庭的CSHCN照护费用。

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