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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Managed care organization characteristics and outpatient specialty care use among children with chronic illness.
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Managed care organization characteristics and outpatient specialty care use among children with chronic illness.

机译：慢性病患儿的管理式护理组织特征和门诊专业护理使用。

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BACKGROUND: Limited information is available about managed care organization (MCO) characteristics that influence outpatient physician specialist use among children with chronic conditions. OBJECTIVE: To examine the association between MCO characteristics and outpatient physician specialist use among children with chronic conditions who were receiving care in MCOs in which primary care providers (PCPs) served as gatekeepers for referrals and who were publicly insured. DESIGN AND METHODS: A total of 2333 children who had been diagnosed with a chronic condition and had functional limitations, an increased need for or use of health care services beyond what children normally use, and/or dependence on medications or home medical equipment were included in the study. The odds of an outpatient physician specialist visit 1 year after study entry were examined as a function of child health and sociodemographic characteristics, MCO characteristics, the child's prior specialty care use, and provider availabilityin the MCO service delivery area. RESULTS: Children cared for in MCOs with lower percentages of PCPs paid on a fee-for-service basis (odds ratio: 0.95; 95% confidence interval: 0.92-0.98), with higher percentages of pediatricians in the PCP network (odds ratio: 1.17; 95% confidence interval: 1.07-1.29), and offering financial incentives for meeting quality of care standards (odds ratio: 1.71; 95% confidence interval: 1.28-2.29) had greater odds of outpatient physician specialist visits. Black children had odds of specialty care that were approximately one half those of white children. Children with prior physician specialist use were 52% more likely to have a physician specialist visit in the year after study entry. The children's diagnoses and condition consequences were not related significantly to the odds of a specialty visit. CONCLUSIONS: Specific MCO characteristics were associated with greater specialty care use among a group of low-income children with chronic conditions. Such information should be used to improve the structure of managed care arrangements for these vulnerable children.
机译：背景：关于托管医疗组织（MCO）特征的信息有限，这会影响患有慢性病的儿童中门诊医生的使用。目的：研究在由初级保健提供者（PCP）担任转诊看门人并已获得公共保险的MCO中接受照料的患有慢性疾病的儿童中，MCO特征与门诊医生专职人员之间的联系。设计与方法：总共包括2333名被诊断出患有慢性疾病并有功能限制的儿童，超出其正常使用范围和/或对药物或家用医疗设备的依赖性，对医疗保健服务的需求或使用增加了在研究中。在研究进入1年后，门诊医师就诊的几率根据儿童健康状况和社会人口统计学特征，MCO特征，儿童先前的专科护理用途以及MCO服务提供地区的提供者可利用性进行了检查。结果：在MCO中照料的儿童，按服务付费的PCP百分比较低（赔率：0.95; 95％置信区间：0.92-0.98），PCP网络中的儿科医生比例较高（赔率： 1.17; 95％的置信区间：1.07-1.29），并为符合护理质量标准提供经济诱因（赔率：1.71; 95％的置信区间：1.28-2.29），门诊就诊医生的几率更大。黑人儿童接受特殊护理的几率约为白人儿童的一半。在研究进入后的一年内，曾有医生专科医生使用的孩子接受医生专科医生访问的可能性增加了52％。儿童的诊断和状况后果与专科就诊的几率无关。结论：特定的MCO特征与一组患有慢性疾病的低收入儿童的特殊护理使用量增加有关。此类信息应用于改善这些弱势儿童的管理式照护安排的结构。

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