Menachemi Nir, Blackburn Justin, Sen Bisakha, Morrisey Michael A, Becker David J, Caldwell Cathy, Kilgore Meredith L
University of Alabama at Birmingham, 1530 3rd Avenue S., Birmingham, AL 35294, USA.
Clin Pediatr (Phila). 2012 Mar;51(3):247-53. doi: 10.1177/0009922811420713. Epub 2011 Sep 2.
This study evaluates the impact of coverage in ALL Kids, the Alabama Child Health Insurance Program (CHIP), by examining asthma-related utilization and outcomes among children continuously enrolled for 3 years (N = 1954)with persistent asthma at enrollment. Outcomes and costs were compared for the first, second, and third years of enrollment using repeated measures analysis of variance and controlling for age, gender, and year fixed-effects. Compared with subsequent years, first year enrollment utilization was higher for asthma-related hospitalizations (6% vs 2% vs 2%; P < .0001) and emergency visits (10% vs 3% vs 2%; P < .0001). Also decreasing were asthma-related outpatient visits (1.46 vs 1.12 vs 0.94; P < .0001), quick-relief prescriptions (2.6 vs 2.2 vs 2.1; P < .0001), and long-term control prescriptions (5.8 vs 5.2 vs 4.4; P < .0001). As a result, significant declines in the mean costs per child were observed. Ongoing ALL Kids coverage is associated with improved disease-management and lower costs for persistent asthma.
本研究通过调查连续3年登记在册(N = 1954)且在登记时患有持续性哮喘的儿童中与哮喘相关的医疗服务利用情况和治疗结果,评估阿拉巴马儿童健康保险计划(CHIP)“所有儿童”项目的覆盖范围所产生的影响。使用重复测量方差分析并控制年龄、性别和年份固定效应,对登记的第一年、第二年和第三年的治疗结果和费用进行了比较。与随后几年相比,第一年登记时与哮喘相关的住院率(6%对2%对2%;P <.0001)和急诊就诊率(10%对3%对2%;P <.0001)更高。与哮喘相关的门诊就诊次数(1.46对1.12对0.94;P <.0001)、快速缓解药物处方(2.6对2.2对2.1;P <.0001)和长期控制药物处方(5.8对5.2对4.4;P <.0001)也在减少。结果,观察到每个儿童的平均费用显著下降。持续的“所有儿童”项目覆盖与持续性哮喘的疾病管理改善和成本降低相关。