Stephens John R, Steiner Michael J, DeJong Neal, Rodean Jonathan, Hall Matt, Richardson Troy, Berry Jay G
*Division of General Pediatrics and Adolescent Medicine, University of North Carolina, School of Medicine, Chapel Hill, NC †Children's Hospital Association, Overland Park, KS ‡Department of Medicine, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
J Pediatr Gastroenterol Nutr. 2017 Jan;64(1):31-36. doi: 10.1097/MPG.0000000000001210.
The aim of the study was to examine the prevalence of diagnosis and treatment for constipation among children receiving Medicaid and to compare healthcare utilization and spending for constipation among children based on number of complex chronic conditions (CCCs).
Retrospective cohort study of 4.9 million children ages 1 to 17 years enrolled in Medicaid from 2009 to 2011 in 10 states in the Truven Marketscan Database. Constipation was identified using International Classification of Disease, 9th revision codes for constipation (564.0x), intestinal impaction (560.3x), or encopresis (307.7). Outpatient and inpatient utilization and spending for constipation were assessed. CCC status was identified using validated methodology.
A total of 267,188 children (5.4%) were diagnosed with constipation. Total constipation spending was $79.5 million. Outpatient constipation spending was $66.8 million (84.1%) during 406,814 visits, mean spending $120/visit. Among children with constipation, 1363 (0.5%) received inpatient treatment, accounting for $12.2 million (15.4%) of constipation spending, mean spending $7815/hospitalization. Of children hospitalized for constipation, 552 (40.5%) did not have an outpatient visit for constipation before admission. Approximately 6.8% of children in the study had ≥1 CCC; these children accounted for 33.5% of total constipation spending, 70.3% of inpatient constipation spending, and 19.8% of emergency department constipation spending. Constipation prevalence was 11.0% for children with 1 CCC, 16.6% with 2 CCCs, and 27.1% with ≥3 CCCs.
Although the majority of pediatric constipation treatment occurs in the outpatient setting, inpatient care accounts for a sizable percentage of spending. Children with CCCs have a higher prevalence of constipation and account for a disproportionate amount of constipation healthcare utilization and spending.
本研究旨在调查参加医疗补助计划的儿童中便秘的诊断和治疗情况，并根据复杂慢性病（CCC）的数量比较儿童便秘的医疗服务利用情况和费用支出。
对Truven Marketscan数据库中2009年至2011年在10个州参加医疗补助计划的490万名1至17岁儿童进行回顾性队列研究。使用国际疾病分类第9版中便秘（564.0x）、肠梗阻（560.3x）或大便失禁（307.7）的编码来识别便秘。评估便秘的门诊和住院利用情况及费用支出。使用经过验证的方法确定CCC状态。
共有267,188名儿童（5.4%）被诊断为便秘。便秘总费用为7950万美元。门诊便秘费用为6680万美元（84.1%），共406,814次就诊，平均每次就诊费用为120美元。在便秘儿童中，1363名（0.5%）接受了住院治疗，占便秘费用的1220万美元（15.4%），平均每次住院费用为7815美元。因便秘住院的儿童中，552名（40.5%）在入院前没有因便秘进行门诊就诊。研究中约6.8%的儿童患有≥1种CCC；这些儿童占便秘总费用的33.5%、住院便秘费用的70.3%和急诊科便秘费用的19.8%。患有1种CCC的儿童便秘患病率为11.0%，患有2种CCC的儿童为16.6%，患有≥3种CCC的儿童为27.1%。
尽管大多数儿科便秘治疗在门诊进行，但住院护理占费用支出的相当大比例。患有CCC的儿童便秘患病率较高，且在便秘医疗服务利用和费用支出中占比过高。
