Miller Katherine E, Hoyt Richard, Rust Steve, Doerschuk Rachel, Huang Yungui, Lin Simon M
Research Information Solutions and Innovation, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States.
Partners for Kids, Nationwide Children's Hospital, Columbus, OH, United States.
Front Public Health. 2020 Feb 28;8:58. doi: 10.3389/fpubh.2020.00058. eCollection 2020.
Previous studies revealed patients with genetic disease have more frequent and longer hospitalizations and therefore higher healthcare costs. To understand the financial impact of genetic disease on a pediatric accountable care organization (ACO), we analyzed medical claims from 2014 provided by Partners for Kids, an ACO in partnership with Nationwide Children's Hospital (NCH; Columbus, OH, USA). Study population included insurance claims from 258,399 children. We assigned patients to four different categories (1-A, 1-B, 2, & 3) based on the strength of genetic basis of disease. We identified 22.7% of patients as category 1A or 1B- having a disease with a "strong genetic basis" (e.g., single gene diseases, chromosomal abnormalities). Total ACO paid claims in 2014 were $379M, of which $161M (42.5%) was attributed to category 1 patients. Furthermore, we identified 23.3% of patients as category 2- having a disease with a suspected genetic component or predisposition (e.g., asthma, type 1 diabetes)- whom accounted for an additional 28.6% of 2014 costs. Category 1 patients were more likely to experience at least one hospitalization compared to category 3 patients- those without genetic disease [odds ratio [OR] = 4.12; 95% confidence interval [CI] = 3.86-4.39; < 0.0001]. Overall, category 1 patients experienced nearly five times the number of inpatient (IP) admissions and twice the number of outpatient (OP) visits compared to category 3 patients ( < 0.0001). Nearly half (42.5%) of healthcare paid claims cost in 2014 for this study population were accounted for by patients with single-gene diseases or chromosomal abnormalities. These findings precede and support a need for an ACO to plan for effective healthcare strategies and capitation models for children with genetic disease.
以往研究表明，患有遗传疾病的患者住院频率更高、住院时间更长，因此医疗费用也更高。为了解遗传疾病对儿科责任医疗组织（ACO）的财务影响，我们分析了与美国俄亥俄州哥伦布市全国儿童医院（NCH）合作的ACO“儿童伙伴”提供的2014年医疗索赔数据。研究人群包括来自258,399名儿童的保险索赔。我们根据疾病遗传基础的强度将患者分为四个不同类别（1 - A、1 - B、2和3）。我们将22.7%的患者确定为1A或1B类——患有“强遗传基础”的疾病（如单基因疾病、染色体异常）。2014年ACO支付的索赔总额为3.79亿美元，其中1.61亿美元（42.5%）归因于1类患者。此外，我们将23.3%的患者确定为2类——患有疑似遗传成分或易感性的疾病（如哮喘、1型糖尿病）——这些患者占2014年费用的另外28.6%。与3类患者（即无遗传疾病的患者）相比，1类患者更有可能至少经历一次住院治疗[优势比（OR）= 4.12；95%置信区间（CI）= 3.86 - 4.39；P < 0.0001]。总体而言，与3类患者相比，1类患者的住院（IP）入院次数几乎是其五倍，门诊（OP）就诊次数是其两倍（P < 0.0001）。2014年该研究人群中近一半（42.5%）的医疗支付索赔费用由患有单基因疾病或染色体异常的患者承担。这些发现为ACO制定针对遗传疾病儿童的有效医疗策略和按人头付费模式提供了前期依据并提供了支持。
