NYU School of Medicine, New York, New York, USA.
University of Chicago School of Medicine, 5841 S Maryland AveChicago, Illinois, USA.
Pediatr Diabetes. 2021 Aug;22(5):816-822. doi: 10.1111/pedi.13218. Epub 2021 May 6.
This study evaluated costs and healthcare utilization associated with a culturally-sensitive, medical and education program for pediatric Latino patients with type 1 diabetes.
Program participants included Latino children ages 1-20 years old diagnosed with type 1 diabetes (n = 57). Control subjects with type 1 diabetes were matched by age, sex, and zip code to intervention participants from the Colorado All Payer Claims Database. Data included emergency department (ED) visits, hospitalizations, demographic information, and health insurance claims data 180 days prior to program start/index date through 1 year after program start/index date. We tracked program staff time and estimated costs for healthcare utilization using data from the scientific literature. Generalized Estimating Equation (GEE) models with logit link were used to estimate group differences in probabilities of ED visits and hospitalizations over 6-month periods pre/post-study, accounting for correlation of within-subject data across time points. Sensitivity analyses modeled longer-term cost differences under different assumptions.
The intervention group had fewer hospitalizations, 2% versus 12% of controls (p = 0.047,OR = 0.13;95%CI: 0.02-0.97) for 6 months following start date. The intervention group had fewer ED visits, 19% versus 32% in controls (n.s.; p = 0.079,OR = 0.52;95%CI:0.25-1.08) and significantly fewer hospitalizations, 4% versus 15% of controls (p = 0.039,OR = 0.21;95%CI: 0.05-0.93) 6-12 months post-start date. One-year per-patient program costs of $633 and healthcare cost savings of $2710 yielded total per-patient savings of $2077, or a 5-year cost savings of $14,106.
This unique type 1 diabetes management program altered health service utilization of program participants, reducing major healthcare cost drivers, ED visits, and hospitalizations.
本研究评估了针对患有 1 型糖尿病的拉丁裔儿科患者的一项文化敏感型医学和教育项目相关的成本和医疗保健利用情况。
该项目的参与者包括年龄在 1-20 岁之间被诊断患有 1 型糖尿病的拉丁裔儿童（n=57）。对照参与者则按照年龄、性别和邮政编码与来自科罗拉多州所有支付者索赔数据库的干预参与者相匹配。数据包括急诊就诊（ED）、住院、人口统计信息和健康保险索赔数据，这些数据在项目启动/索引日期前 180 天至项目启动/索引日期后 1 年内进行跟踪。我们使用科学文献中的数据来跟踪项目工作人员的时间并估算医疗保健利用的成本。使用广义估计方程（GEE）模型和对数链接来估计研究前/后 6 个月内 ED 就诊和住院的组间差异，同时考虑到了各时间点的个体内数据相关性。敏感性分析根据不同的假设对长期成本差异进行建模。
干预组在研究启动后 6 个月内的住院率较低，为 2%，而对照组为 12%（p=0.047，OR=0.13；95%CI：0.02-0.97）。干预组的 ED 就诊次数较少，为 19%，而对照组为 32%（无统计学意义；p=0.079，OR=0.52；95%CI：0.25-1.08），且住院率显著降低，为 4%，而对照组为 15%（p=0.039，OR=0.21；95%CI：0.05-0.93），在研究启动后 6-12 个月。每位患者每年 633 美元的项目成本和 2710 美元的医疗保健成本节省，使得每位患者的总节省成本为 2077 美元，或 5 年节省成本 14106 美元。
这种独特的 1 型糖尿病管理项目改变了项目参与者的医疗服务利用情况，减少了主要的医疗保健成本驱动因素，如 ED 就诊和住院。
