Complex Care, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2023 Oct 2;6(10):e2339449. doi: 10.1001/jamanetworkopen.2023.39449.
Although durable medical equipment and supplies (DMES) are commonly used to optimize the health and function in pediatric patients, little is known about the prevalence of use and spending on DMES.
To categorize the Healthcare Common Procedure Coding System (HCPCS) for distinguishing DMES types, and to measure the prevalence and related spending of DMES in pediatric patients using Medicaid.
DESIGN, SETTING, AND PARTICIPANTS: This study is a cross-sectional analysis of the 2018 Merative Medicaid Database and included 4 569 473 pediatric patients aged 0 to 21 years enrolled in Medicaid in 12 US states from January 1 to December 31, 2018. Data were analyzed from February 2019 to April 2023.
DMES exposure was identified with the Centers for Medicare & Medicaid Services HCPCS codes. Three pediatricians categorized HCPCS DMES codes submitted by vendors for reimbursement of dispensed DMES into DMES types and end-organ systems; 15 expert reviewers refined the categorization (2576 DMES codes, 164 DMES types, 14 organ systems).
The main outcome was DMES prevalence & Medicaid spending. The χ2 test was used to compare DMES prevalence and Wilcoxon rank sum tests were used to compare per-member-per-year (PMPY) spending by complex chronic conditions (CCC).
Of the 4 569 473 patients in the study cohort, 49.3% were female and 56.1% were aged 5 to 15 years. Patients used 133 of 164 (81.1%) DMES types. The DMES prevalence was 17.1% (95% CI, 17.0%-17.2%) ranging from 10.1% (95% CI, 10.0%-10.2%) in patients with no chronic condition to 60.9% (95% CI, 60.8%-61.0%) for patients with 2 or more CCCs. The PMPY DMES spending was $593, ranging from $349 for no chronic condition to $4253 for 2 or more CCCs. Lens (7.9%), vision frames (6.2%), and orthotics for orthopedic injury (0.8%) were the most common DME in patients with no chronic condition. Enteral tube / feeding supplies (19.8%), diapers (19.2%), lower extremity orthotics (12.3%), wheelchair (9.6%), oxygen (9.0%), and urinary catheter equipment (4.2%) were among the most common DMES in children with 2 or more CCCs.
In this cross-sectional study, HCPCS distinguished a variety of DME types and use across pediatric populations. Further investigation should assess the utility of the HCPCS DMES categorization with efforts to optimize the quality and safety of DMES use.
尽管耐用医疗设备和用品（DMES）常用于优化儿科患者的健康和功能，但人们对其使用的普遍性和相关支出知之甚少。
对医疗保健通用程序编码系统（HCPCS）进行分类，以区分 DMES 类型，并衡量使用医疗补助计划的儿科患者 DMES 的流行程度和相关支出。
设计、设置和参与者：本研究是对 2018 年 Merative 医疗补助数据库的横断面分析，纳入了 2018 年 1 月 1 日至 12 月 31 日期间美国 12 个州中年龄在 0 至 21 岁之间的 4569473 名医疗补助计划的儿科患者。数据于 2019 年 2 月至 2023 年 4 月进行分析。
DMES 暴露是通过医疗保险和医疗补助服务中心 HCPCS 代码识别的。三位儿科医生将供应商提交的用于报销配给 DMES 的 HCPCS DMES 代码归类为 DMES 类型和终末器官系统；15 位专家评审员对分类进行了细化（2576 个 DMES 代码，164 个 DMES 类型，14 个器官系统）。
主要结果是 DMES 的流行程度和医疗补助支出。χ2 检验用于比较 DMES 的流行程度，Wilcoxon 秩和检验用于比较复杂慢性疾病（CCC）患者的每成员每年（PMPY）支出。
在研究队列的 4569473 名患者中，49.3%为女性，56.1%为 5 至 15 岁。患者使用了 164 种 DMES 类型中的 133 种（81.1%）。DMES 的流行率为 17.1%（95%CI，17.0%-17.2%），范围从无慢性疾病患者的 10.1%（95%CI，10.0%-10.2%）到有 2 种或更多 CCC 患者的 60.9%（95%CI，60.8%-61.0%）。PMPY 的 DMES 支出为 593 美元，从无慢性疾病患者的 349 美元到有 2 种或更多 CCC 患者的 4253 美元不等。镜片（7.9%）、视力框架（6.2%）和矫形创伤用矫形器（0.8%）是无慢性疾病患者中最常见的 DMES。肠内管/喂养用品（19.8%）、尿布（19.2%）、下肢矫形器（12.3%）、轮椅（9.6%）、氧气（9.0%）和导尿设备（4.2%）是有 2 种或更多 CCC 儿童中最常见的 DMES。
在这项横断面研究中，HCPCS 区分了儿科人群中各种 DMES 类型和用途。进一步的研究应评估 HCPCS DMES 分类的效用，并努力优化 DMES 使用的质量和安全性。
