Coker Tumaini R, Lowry Sarah J, Dwibedi Esha, Salaguinto Taylor, Szilagyi Peter G, Fiscella Kevin, Rangel Sairan J, Ortiz Janette, Weaver Marcia R
Seattle Children's Research Institute, Seattle Children's, Seattle, Washington.
Department of Pediatrics, University of Washington School of Medicine, Seattle.
JAMA Netw Open. 2025 Jul 1;8(7):e2522732. doi: 10.1001/jamanetworkopen.2025.22732.
The Parent-Focused Redesign for Encounters, Newborns to Toddlers (PARENT) trial demonstrated increased anticipatory guidance and well child care visit (WCV) attendance but no effect on emergency department (ED) utilization.
To assess whether the PARENT intervention was associated with lower non-WCV costs, and whether the increasing WCV attendance might offset recurring intervention costs.
DESIGN, SETTING, AND PARTICIPANTS: The PARENT cluster-randomized clinical trial was conducted from March 5, 2019, to July 14, 2022. This secondary cost analysis was conducted throughout the trial and continued to November 15, 2024. Participants included 937 enrolled parents with a child younger than 2 years presenting for a WCV at 10 clinics from 2 federally qualified health centers (FQHCs). Data on utilization and estimated cost of care using a unit cost approach were collected. Parents were interviewed at baseline and 6 and 12 months and asked about the number of encounters and the child's diagnosis for subspecialty referrals, urgent care visits, ED visits, and hospitalizations.
PARENT is a team-based approach to health care that uses a trained community health worker as part of the well child care team to provide preventive care services to children aged 0 to 2 years.
The main outcome of this analysis was 2016 unit cost estimates for subspecialty referrals, urgent care visits, ED visits, and hospitalizations by health condition and child's age using data from the US Disease Expenditure Study.
Among 937 enrolled PARENT participants, 785 (83.8%) completed the 12-month interview and were included in analyses. Mean (SD) child age at enrollment was 4.4 (4.0) months, and most participants were mothers (868 of 914 with available data [95.4%]) and were Medicaid insured (855 of 914 with available data [93.5%]). The intervention group had statistically significant lower costs than the control group for both subspecialty referrals (-$213; 95% uncertainty interval [UI], -$540 to -$106) and total cost of urgent care visits, ED visits, and hospitalizations (-$70; 95% UI, -$150 to -$13). Based on the mean (SD) volume of newborns across all participating clinics (5.8 [4.1] newborns per week), marginal revenue from increased WCV attendance was greater than annual community health worker salary and benefits costs under select current reimbursements.
This secondary analysis of a cluster-randomized clinical trial suggests that the cost of the PARENT intervention was offset by savings in non-WCV health care utilization, and revenue for federally qualified health centers from increased WCV attendance could fund ongoing intervention costs.
ClinicalTrials.gov Identifier: NCT03797898.
以父母为中心的新生儿至幼儿就诊重新设计（PARENT）试验表明，预期指导有所增加，儿童健康检查就诊（WCV）的出勤率有所提高，但对急诊科（ED）利用率没有影响。
评估PARENT干预措施是否与较低的非WCV成本相关，以及WCV出勤率的提高是否可能抵消反复出现的干预成本。
设计、地点和参与者：PARENT整群随机临床试验于2019年3月5日至2022年7月14日进行。这项二次成本分析在整个试验过程中进行，并持续到2024年11月15日。参与者包括937名登记的父母，他们的孩子年龄小于2岁，在2个联邦合格健康中心（FQHC）的10家诊所进行WCV。使用单位成本法收集了医疗服务利用和估计护理成本的数据。在基线、6个月和12个月时对父母进行访谈，询问会诊次数以及孩子因专科转诊、紧急护理就诊、急诊科就诊和住院的诊断情况。
PARENT是一种基于团队的医疗保健方法，使用经过培训的社区卫生工作者作为儿童健康护理团队的一部分，为0至2岁的儿童提供预防性护理服务。
该分析的主要结果是使用美国疾病支出研究的数据，按健康状况和儿童年龄对专科转诊、紧急护理就诊、急诊科就诊和住院的2016年单位成本估计。
在937名登记的PARENT参与者中，785名（83.8%）完成了12个月的访谈并纳入分析。入组时儿童的平均（标准差）年龄为4.4（4.0）个月，大多数参与者为母亲（914名有可用数据者中的868名[95.4%]），且参加了医疗补助保险（914名有可用数据者中的855名[93.5%]）。干预组在专科转诊（-213美元；95%不确定区间[UI]，-540至-106美元）以及紧急护理就诊、急诊科就诊和住院的总成本（-70美元；95% UI，-150至-13美元）方面，成本均显著低于对照组。根据所有参与诊所新生儿的平均（标准差）数量（每周5.8[4.1]名新生儿），在当前特定报销情况下，WCV出勤率提高带来的边际收入大于社区卫生工作者的年度工资和福利成本。
这项对整群随机临床试验的二次分析表明，PARENT干预措施的成本被非WCV医疗服务利用方面的节省所抵消，联邦合格健康中心因WCV出勤率提高而获得的收入可以支付持续的干预成本。
ClinicalTrials.gov标识符：NCT03797898。
