Department of Pediatrics, School of Medicine, Stanford University, Stanford, California;
Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado.
Pediatrics. 2020 Apr;145(4). doi: 10.1542/peds.2019-2401.
Children with medical complexity (CMC) comprise only 6% of the pediatric population, account for ∼40% of pediatric health care spending, and provide an important opportunity for cost saving. Savings in this group can have an important impact on pediatric health care costs. The objective of this study was to assess the impact of a multicenter care management program on spending and use in CMC.
We conducted a prospective cohort analysis of a population of 4530 CMC enrolled in a learning collaborative designed to improve care for CMC ages 0 to 21 years identified using 3M Clinical Risk Group categories 5b through 9. The primary outcome was total per-member per-year standardized spending; secondary outcomes included inpatient and emergency department (ED) spending and use. We used a 1:1 propensity score match to compare enrolled patients to eligible nonenrolled patients and statistical process control methods to analyze spending and usage rates.
Comparison with the matched group showed a 4.6% (95% confidence interval [CI]: 1.9%-7.3%) decrease in total per-member per-year spending ( < .001), a 7.7% (95% CI: 1.2%-13.5%) decrease in inpatient spending ( = .04), and an 11.6% (95% CI: 3.9%-18.4%) decrease in ED spending ( = .04). Statistical process control analysis showed a decrease in hospitalization rate and ED visits.
CMC enrolled in a learning collaborative showed significant decreases in total spending and a significant decrease in the number of hospitalizations and ED visits. Additional research is needed to determine more specific causal factors for the results and if these results are sustainable over time and replicable in other settings.
患有复杂疾病的儿童（CMC）仅占儿科人群的 6%，但占儿科医疗支出的 40%左右，为节省成本提供了重要机会。在该人群中节省成本可能会对儿科医疗保健成本产生重要影响。本研究的目的是评估多中心护理管理计划对 CMC 患者的支出和使用的影响。
我们对参加学习合作的 4530 名患有复杂疾病的儿童进行了前瞻性队列分析，该合作旨在改善使用 3M 临床风险组类别 5b 至 9 识别的 0 至 21 岁患有复杂疾病的儿童的护理。主要结果是每个成员每年的标准化支出总额；次要结果包括住院和急诊（ED）支出和使用。我们使用 1:1 倾向评分匹配来比较已登记患者与符合条件的未登记患者，并使用统计过程控制方法来分析支出和使用比率。
与匹配组的比较显示，总成员每年支出（标准化）降低了 4.6%（95%置信区间：1.9%-7.3%）（<.001），住院支出降低了 7.7%（95%置信区间：1.2%-13.5%）（=.04），ED 支出降低了 11.6%（95%置信区间：3.9%-18.4%）（=.04）。统计过程控制分析显示住院率和 ED 就诊次数减少。
参加学习合作的患有复杂疾病的儿童的总支出显著下降，住院和 ED 就诊次数也显著减少。需要进一步研究以确定结果的更具体因果因素，以及这些结果是否随着时间的推移具有可持续性，是否可以在其他环境中复制。
