1 University of Tennessee , College of Nursing, Knoxville, Tennessee.
J Palliat Med. 2013 Nov;16(11):1388-93. doi: 10.1089/jpm.2013.0099. Epub 2013 Oct 8.
As the United States braces for full implementation of health care reform, the eyes of the nation are on Medicaid. The large number of newly eligible Medicaid beneficiaries may challenge health care resources and ultimately impact quality of care. This is a special concern among current Medicaid beneficiaries such as children with complex chronic conditions (CCCs) who have significant health care needs, especially at end of life (EOL). Yet, a comprehensive profile of these children is lacking.
To understand the demographic and health characteristics, health care utilization, and expenditures among Medicaid children with CCCs at EOL.
Our study used a retrospective cohort design with data from the 2007 and 2008 California Medicaid data files. Descriptive statistics were used to profile children in the last year of life.
We found a diverse group of children who suffered with serious, multiple chronic conditions, and who accessed comprehensive, multidisciplinary care. Most children had neuromuscular conditions (54%), cardiovascular conditions (46%), and cancer (30%). A majority (56%) had multiple CCCs. Children with CCCs received comprehensive care including hospital inpatient (67%), primary (82%), ancillary (87%), and other acute care services (83%); however, few children utilized hospice and home health care services (26%). Significant age differences existed among the children.
The current California Medicaid system appears to provide comprehensive care for children at EOL. The underutilization of hospice and home health services, however, represents an opportunity to improve the quality of EOL care while potentially reducing or remaining budget neutral.
随着美国为全面实施医疗改革做准备，全国的目光都集中在医疗补助计划（Medicaid）上。大量新符合条件的医疗补助计划受益人可能会对医疗资源构成挑战，并最终影响医疗质量。这是当前医疗补助计划受益人的一个特别关注点，例如患有复杂慢性病（CCC）的儿童，他们有重大的医疗需求，尤其是在生命末期（EOL）。然而，目前缺乏对这些儿童的全面描述。
了解即将离世的 Medicaid 儿童复杂慢性病患者的人口统计学和健康特征、医疗保健利用情况和支出。
我们的研究使用了回顾性队列设计，数据来自 2007 年和 2008 年加利福尼亚州医疗补助数据文件。使用描述性统计来描述生命最后一年的儿童情况。
我们发现了一个多样化的儿童群体，他们患有严重的、多种慢性疾病，并接受了全面的、多学科的护理。大多数儿童患有神经肌肉疾病（54%）、心血管疾病（46%）和癌症（30%）。大多数（56%）儿童有多种 CCC。患有 CCC 的儿童接受了全面的护理，包括医院住院治疗（67%）、初级护理（82%）、辅助治疗（87%）和其他急性护理服务（83%）；然而，只有少数儿童利用了临终关怀和家庭保健服务（26%）。儿童之间存在显著的年龄差异。
目前加利福尼亚州的 Medicaid 系统似乎为生命末期的儿童提供了全面的护理。然而，临终关怀和家庭保健服务的利用不足，这为提高临终关怀质量提供了机会，同时有可能减少或保持预算中性。
