Garrity Brigid M, Perrin James M, Rodean Jonathan, Houtrow Amy J, Shelton Charlene, Stille Christopher, McLellan Sarah, Coleman Cara, Mann Marie, Kuhlthau Karen, Desmarais Anna, Berry Jay G
Division of General Pediatrics, Boston Children's Hospital (BM Garrity, A Desmarais, and JG Berry), Boston, Mass.
Division of General Academic Pediatrics, MassGeneral Hospital for Children (JM Perrin), Boston, Mass; Department of Pediatrics, Harvard Medical School (JM Perrin and JG Berry), Boston, Mass.
Acad Pediatr. 2023 Mar;23(2):441-447. doi: 10.1016/j.acap.2022.07.008. Epub 2022 Jul 18.
To assess the number of days that children experienced a health care encounter and associations between chronic condition types and health care encounters.
Retrospective analysis of data from 5,082,231 children ages 0 to 18 years enrolled in Medicaid during 2017 in 12 US states contained in the IBM Watson Marketscan Medicaid Database. We counted and categorized enrollees' encounter days, defined as unique days a child had a health care visit, by type of health service. We used International Classification of Disease-10 diagnosis code categories from Agency for Healthcare Research and Quality's Chronic Condition Indicator System to identify chronic mental and physical health conditions.
Median (interquartile range [IQR]) annual encounter days was 6 (2-13). Children in the 91st to 98th and ≥99th percentiles for encounter days experienced a median of 49 (IQR 38-70) and 229 (IQR 181, 309) days, respectively; these children accounted for 52.6% of days for the cohort. As encounter days increased from the 25th to >90th percentile, the percentage of children with co-existing mental and physical health conditions increased from <0.1% to 47.4% (P < .001). Outpatient visits accounted for a total of 68.3% and 62.2% of days for children the 91st to 98th and ≥99th percentiles.
Ten percent of children enrolled in Medicaid averaged health care encounters at least 1 day per week; 1% experienced health care encounters on most weekdays. Further investigation is needed to understand how families perceive frequent health care encounters, including how to facilitate their children's care in the most feasible way.
评估儿童经历医疗保健就诊的天数，以及慢性病类型与医疗保健就诊之间的关联。
对2017年美国12个州参加医疗补助计划的5,082,231名0至18岁儿童的数据进行回顾性分析，这些数据包含在IBM Watson Marketscan医疗补助数据库中。我们按医疗服务类型对登记者的就诊天数进行计数和分类，就诊天数定义为儿童进行医疗保健就诊的独特天数。我们使用医疗保健研究与质量局慢性病指标系统中的国际疾病分类第10版诊断代码类别来识别慢性精神和身体健康状况。
年度就诊天数的中位数（四分位间距[IQR]）为6天（2 - 13天）。就诊天数处于第91至98百分位和≥99百分位的儿童，其就诊天数中位数分别为49天（IQR 38 - 70天）和229天（IQR 181 - 309天）；这些儿童占该队列总天数的52.6%。随着就诊天数从第25百分位增加到>90百分位，同时患有精神和身体健康状况的儿童比例从<0.1%增加到47.4%（P < .001）。门诊就诊分别占就诊天数处于第91至98百分位和≥99百分位儿童总天数的68.3%和62.2%。
参加医疗补助计划的儿童中有10%平均每周至少有1天进行医疗保健就诊；1%的儿童在大多数工作日都有医疗保健就诊。需要进一步调查以了解家庭如何看待频繁的医疗保健就诊，包括如何以最可行的方式为孩子提供便利的医疗服务。
