Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA.
Evidence-to-Impact Collaborative, Social Science Research Institute, Penn State University, State College, PA.
J Pediatr. 2021 Jun;233:82-89.e1. doi: 10.1016/j.jpeds.2021.01.067. Epub 2021 Feb 3.
To describe longitudinal health care utilization of Medicaid-insured children with a history of neonatal abstinence syndrome (NAS) compared with similar children without NAS.
Retrospective, longitudinal cohort study. Data were extracted from the Medicaid Analytic eXtract files for all available states and DC from 2003-2013. Subjects were followed up to 11 years. In total, 17 229 children with NAS were identified using the International Classification of Diseases, Ninth Revision code 779.5. Children without NAS, matched on demographic and health variables, served as the comparison group. Outcomes were number of claims for inpatient, outpatient, and emergency department encounters, numbers of prescription claims, and costs associated with these services. Linked claims were identified for each subject using a unique, within-state ID.
Children with NAS had increased claims for inpatient admissions (marginal effect [ME] 0.49; SE 0.01) and emergency department visits (ME 0.30; SE 0.04) through year 1; increased prescriptions (ME 1.45; SE 0.08, age 0) (ME 0.69; SE 0.11, age 1 year) through year 2; and increased outpatient encounters (ME 20.13; SE 0.54, age 0) (ME 3.95; SE 0.62, age 1 year) (ME 2.90; SE 1.11, age 2 years) through year 3 after adjusting for potential confounders (P < .01 for all). Beyond the third year, health care utilization was similar between those with and without NAS.
Children with a diagnosis of NAS have greater health care utilization through the third year of life. These differences resolve by the fourth year. Our results suggest resolution of disparities may be due to shifts in developmental health management in school-age children and inability to track relevant diagnoses in a health care database.
描述有新生儿戒断综合征（NAS）病史的医疗补助保险儿童与无 NAS 儿童相比的纵向医疗保健利用情况。
回顾性、纵向队列研究。数据从 2003 年至 2013 年从 Medicaid Analytic eXtract 文件中提取，适用于所有州和哥伦比亚特区。对参与者进行了长达 11 年的随访。共确定了 17229 例使用国际疾病分类，第九版代码 779.5 的 NAS 儿童。无 NAS 的儿童，按人口统计学和健康变量匹配，作为对照组。结果是住院、门诊和急诊就诊的索赔次数、处方数量以及与这些服务相关的费用。通过每个主体的唯一州内 ID 识别相关联的索赔。
通过第 1 年，NAS 儿童的住院入院（边际效应[ME]0.49；SE0.01）和急诊就诊（ME0.30；SE0.04）的索赔增加；通过第 2 年，处方增加（ME1.45；SE0.08，年龄 0）（ME0.69；SE0.11，年龄 1 岁）；通过第 3 年，门诊就诊（ME20.13；SE0.54，年龄 0）（ME3.95；SE0.62，年龄 1 岁）（ME2.90；SE1.11，年龄 2 岁），在调整潜在混杂因素后（所有 P<0.01）。在第三年之后，有和没有 NAS 的儿童的医疗保健利用情况相似。
被诊断为 NAS 的儿童在生命的第三年内有更多的医疗保健利用。这些差异在第四年得到解决。我们的研究结果表明，差异的解决可能是由于学龄儿童发育健康管理的转变以及在医疗保健数据库中无法跟踪相关诊断。
