Complex Care Service, Division of General Pediatrics,
Division of Orthopedic Surgery, Department of Surgery.
Pediatrics. 2017 Oct;140(4). doi: 10.1542/peds.2017-1233. Epub 2017 Sep 12.
Global payment is used with surgeries to optimize health, lower costs, and improve quality. We assessed perioperative spending on spinal fusion for scoliosis to inform how this might apply to children.
Retrospective analysis of 1249 children using Medicaid and aged ≥5 years with a complex chronic condition undergoing spinal fusion in 2013 from 12 states. From perioperative health services measured 6 months before and 3 months after spinal fusion, we simulated a spending reallocation with increased preoperative care and decreased hospital care.
Perioperative spending was $112 353 per patient, with 77.9% for hospitalization, 12.3% for preoperative care, and 9.8% for postdischarge care. Primary care accounted for 0.2% of total spending; 15.4% and 49.2% of children had no primary care visit before and after spinal fusion, respectively. Compared with having no preoperative primary care visit, 1 to 2 visits were associated with a 12% lower surgery hospitalization cost ( = .05) and a 9% shorter length of stay (LOS) ( = .1); ≥3 visits were associated with a 21% lower hospitalization cost ( < .001) and a 14% shorter LOS ( = .01). Having ≥3 preoperative primary care visits for all children would increase total perioperative spending by 0.07%. This increased cost could be underwritten by a 0.1% reduction in hospital LOS or a 1.0% reduction in 90-day hospital readmissions.
Hospital care accounted for most perioperative spending in children undergoing spinal fusion. Multiple preoperative primary care visits were associated with lower hospital costs and shorter hospitalizations. Modestly less hospital resource use could underwrite substantial increases in children's preoperative primary care.
全球支付被用于手术，以优化健康状况、降低成本和提高质量。我们评估了脊柱融合术治疗脊柱侧凸的围手术期支出，以了解这如何适用于儿童。
对 2013 年来自 12 个州的 1249 名年龄≥5 岁、患有复杂慢性病并接受脊柱融合术的 Medicaid 患者进行回顾性分析。从脊柱融合术前 6 个月和术后 3 个月测量的围手术期健康服务中，我们模拟了增加术前护理和减少医院护理的支出再分配。
每位患者的围手术期支出为 112353 美元，其中 77.9%用于住院治疗，12.3%用于术前护理，9.8%用于出院后护理。初级保健占总支出的 0.2%；15.4%和 49.2%的儿童在脊柱融合术前和术后分别没有接受初级保健就诊。与没有术前初级保健就诊相比，就诊 1-2 次与手术住院费用降低 12%（ =.05）和住院时间缩短 9%（ =.1）相关；就诊≥3 次与住院费用降低 21%（ <.001）和住院时间缩短 14%（ =.01）相关。所有儿童增加≥3 次术前初级保健就诊将增加围手术期总支出 0.07%。这一增加的成本可以通过减少 0.1%的住院时间或减少 90 天内的住院再入院率 1.0%来承担。
在接受脊柱融合术的儿童中，医院护理占围手术期支出的大部分。多次术前初级保健就诊与较低的住院费用和较短的住院时间相关。适度减少医院资源的使用可以为儿童术前初级保健的大幅增加提供资金支持。
