Damiano Peter C, Momany Elizabeth T, Tyler Margaret C, Penziner Andrew J, Lobas Jeffrey G
Health Policy Research Program, University of Iowa, Public Policy Center, 227 S Quadrangle, Iowa City, IA 52242, USA.
Pediatrics. 2006 Oct;118(4):e1187-94. doi: 10.1542/peds.2005-3018.
Our goal was to evaluate the impact of having a medical home on the outpatient medical costs of children and youth with special health care needs.
Data from 2 sources were matched at the individual level: (1) the 2002 Iowa Consumer Assessment of Health Plans Study survey of Medicaid enrollees and (2) Iowa Medicaid administrative claims, encounter, and enrollment files.
The subjects were 1140 children aged 6 months to 12 years for whom both sources of data were available.
MAIN OUTCOME MEASURE(S): Outcomes measures included medical homeness, as developed by a scale of items in the Consumer Assessment of Health Plans Study survey, and outpatient costs, as determined from Medicaid administrative data.
From the regression models, we found that (1) for all Medicaid-enrolled children, outpatient costs were significantly higher for female children and children and youth with special health care needs, (2) for children and youth without special health care needs, costs were significantly higher for female children, those with a personal doctor or nurse, and those with more of a medical home, and (3) for children and youth with special health care needs, costs were significantly higher for those in a lower health state, for those in health maintenance organization 2, and for older children.
Although the degree of medical homeness was not related to outpatient costs for children and youth with special health care needs, medical homeness may affect inpatient costs more than outpatient costs for children and youth with special health care needs and should be investigated further.
我们的目标是评估拥有医疗之家对有特殊医疗需求的儿童和青少年门诊医疗费用的影响。
来自两个来源的数据在个体层面进行匹配：（1）2002年爱荷华州医疗计划消费者评估研究对医疗补助参保者的调查，以及（2）爱荷华州医疗补助管理索赔、诊疗记录和参保档案。
研究对象为1140名6个月至12岁的儿童，这两个数据源都有他们的数据。
结局指标包括医疗之家程度（由医疗计划消费者评估研究调查中的项目量表得出）和门诊费用（由医疗补助管理数据确定）。
从回归模型中，我们发现：（1）对于所有参加医疗补助的儿童，女童以及有特殊医疗需求的儿童和青少年的门诊费用显著更高；（2）对于没有特殊医疗需求的儿童和青少年，女童、有私人医生或护士的儿童以及医疗之家程度更高的儿童的费用显著更高；（3）对于有特殊医疗需求的儿童和青少年，健康状况较差的儿童、参加健康维护组织2的儿童以及年龄较大的儿童的费用显著更高。
虽然医疗之家程度与有特殊医疗需求的儿童和青少年的门诊费用无关，但对于有特殊医疗需求的儿童和青少年，医疗之家程度对住院费用的影响可能大于对门诊费用的影响，应进一步研究。
