Department of Pediatrics, University of Utah, Salt Lake City, UT.
Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital of Colorado, Aurora, CO.
Pediatr Crit Care Med. 2024 Jun 1;25(6):518-527. doi: 10.1097/PCC.0000000000003476. Epub 2024 Mar 6.
To describe family healthcare burden and health resource utilization in pediatric survivors of acute respiratory distress syndrome (ARDS) at 3 and 9 months.
Secondary analysis of a prospective multisite cohort study.
Eight academic PICUs in the United States (2019-2020).
Critically ill children with ARDS and follow-up survey data collected at 3 and/or 9 months after the event.
None.
We evaluated family healthcare burden, a measure of healthcare provided by families at home, and child health resource use including medication use and emergency department (ED) and hospital readmissions during the initial 3- and 9-month post-ARDS using proxy-report. Using multivariable logistic regression, we evaluated patient characteristics associated with family healthcare burden at 3 months.
Of 109 eligible patients, 74 (68%) and 63 patients (58%) had follow-up at 3- and 9-month post-ARDS. At 3 months, 46 families (62%) reported healthcare burden including (22%) with unmet care coordination needs. At 9 months, 33 families (52%) reported healthcare burden including 10 families (16%) with unmet care coordination needs. At month 3, 61 patients (82%) required prescription medications, 13 patients (18%) had ED visits and 16 patients (22%) required hospital readmission. At month 9, 41 patients (65%) required prescription medications, 19 patients (30%) had ED visits, and 16 (25%) required hospital readmission were reported. Medication use was associated with family healthcare burden at both 3 and 9 months. In a multivariable analysis, preillness functional status and chronic conditions were associated with healthcare burden at month 3 but illness characteristics were not.
Pediatric ARDS survivors report high rates of healthcare burden and health resource utilization at 3- and 9-month post-ARDS. Future studies should assess the impact of improved care coordination to simplify care (e.g., medication management) and improve family burden.
描述急性呼吸窘迫综合征（ARDS）儿科幸存者在 3 个月和 9 个月时的家庭医疗负担和卫生资源利用情况。
前瞻性多中心队列研究的二次分析。
美国 8 家学术性儿科重症监护病房（2019-2020 年）。
患有 ARDS 的危重病儿童，以及在事件发生后 3 个月和/或 9 个月收集的随访调查数据。
无。
我们使用代理报告评估了家庭医疗负担，即家庭在家中提供的医疗保健量，以及包括药物使用、急诊部（ED）和医院再入院在内的儿童健康资源利用情况，在 ARDS 后最初的 3 个月和 9 个月内进行。使用多变量逻辑回归，我们评估了与 3 个月时家庭医疗负担相关的患者特征。
在 109 名符合条件的患者中，有 74 名（68%）和 63 名患者（58%）在 ARDS 后 3 个月和 9 个月进行了随访。在 3 个月时，46 个家庭（62%）报告了医疗负担，其中 22%有未满足的医疗协调需求。在 9 个月时，33 个家庭（52%）报告了医疗负担，其中 10 个家庭（16%）有未满足的医疗协调需求。在 3 个月时，61 名患者（82%）需要处方药物，13 名患者（18%）需要急诊就诊，16 名患者（22%）需要住院再入院。在 9 个月时，41 名患者（65%）需要处方药物，19 名患者（30%）需要急诊就诊，16 名患者（25%）需要住院再入院。在 3 个月和 9 个月时，药物使用与家庭医疗负担相关。在多变量分析中，疾病前的功能状态和慢性疾病与 3 个月时的医疗负担相关，但疾病特征与医疗负担无关。
儿科 ARDS 幸存者在 ARDS 后 3 个月和 9 个月时报告了较高的医疗负担和卫生资源利用。未来的研究应评估改善护理协调以简化护理（例如，药物管理）和减轻家庭负担的效果。
