UCLA-Semel Institute for Neuroscience and Human Behavior, Los Angeles, California.
J Am Acad Child Adolesc Psychiatry. 2021 Mar;60(3):336-337. doi: 10.1016/j.jaac.2020.12.004. Epub 2020 Dec 10.
The National Quality Strategy to transform the US health care system is predicated upon Donald Berwick et al.'s "Triple Aim" envisioning the simultaneous pursuit of improved care, better population health, and reduced costs. More recently, emphasis has been placed on improving the value of health care as defined by "achieving the best patient health outcomes (quality + experience) at the lowest cost." US health care expenditures are projected to grow at an average annual rate of 5.4% during this decade, reaching 19.7% of the gross domestic product or an estimated 6.1 billion dollars by 2028. Compared with 36 high-income countries, including Canada, the US spends nearly twice as much on health care yet has the lowest life expectancy and highest suicide rate. However, solely targeting reduction in mental health care costs is not a solution, because the mental and general health care systems are inextricably linked and for children span multiple care sectors (eg, schools, child welfare, juvenile justice). In this issue of the Journal, Ansari et al. validates the complexity of physically ill children with a comorbid psychiatric disorder among more than 50,000 admissions to an acute-care pediatric specialty hospital within Canada's publicly funded health care system. Almost one out of 10 admissions for a physical illness had a documented comorbid psychiatric disorder, which is consistent with US pediatric hospital discharges. Children who were older, more clinically complex, and with prior hospitalizations were more likely to be among inpatient admissions with a comorbid psychiatric disorder. With outstanding methodologic rigor, the data suggest that pediatric inpatient admissions with comorbid psychiatric disorders had a nearly 10% longer length of stay and higher costs per admission compared with inpatient admissions without a comorbid psychiatric disorder---a difference in total cumulative costs of more than CAN$11.3 million (equivalent of about US$8.4 million).
美国国家医疗质量战略旨在改革其医疗体系，其基础是唐纳德·贝里克（Donald Berwick）等人提出的“三重目标”，即同时追求改善医疗服务、提高人口健康水平和降低成本。最近，人们更加关注提高医疗保健的价值，其定义为“以最低的成本实现最佳的患者健康结果（质量+体验）”。本十年内，美国医疗保健支出预计将以 5.4%的平均年增长率增长，到 2028 年将达到国内生产总值的 19.7%，约为 610 亿美元。与包括加拿大在内的 36 个高收入国家相比，美国在医疗保健上的支出几乎是其两倍，但预期寿命最低，自杀率最高。然而，仅仅针对降低精神保健成本并不是一个解决方案，因为精神和一般保健系统是不可分割的，而且儿童的保健跨越多个保健部门（例如，学校、儿童福利、少年司法）。在本期《美国医学会杂志》上，Ansari 等人通过对加拿大公共资助医疗保健系统内一家急症儿科专科医院超过 50000 例急性入院病例的研究，验证了患有躯体疾病且同时合并精神障碍的儿童的复杂性。在因躯体疾病入院的儿童中，近十分之一有记录的合并精神障碍，这与美国儿科医院的出院情况一致。年龄较大、临床情况较复杂、有住院史的儿童更有可能因合并精神障碍而入院。研究数据具有出色的方法学严谨性，表明与无合并精神障碍的入院相比，合并精神障碍的儿科住院患者的住院时间延长近 10%，每次住院的费用增加近 1130 万加元（相当于约 840 万美元）。
