McConnochie K M, Roghmann K J, Liptak G S
Department of Pediatrics, University of Rochester School of Medicine, New York 14642.
J Pediatr. 1995 Feb;126(2):220-9. doi: 10.1016/s0022-3476(95)70548-1.
Lower respiratory tract illness (LRI) is the most common serious illness in childhood and the most common reason for hospitalization of infants beyond the neonatal period. This study assessed the potential for cost savings from reduction in hospitalization for LRI.
LRI hospitalization rates for children in the first 2 years of life (infants) were studied for the 62 counties of New York State and six socioeconomic areas within Monroe County (Rochester) for the years 1985 through 1991.
Analysis of small area variations.
LRI accounted for 51.2% of infant hospitalizations in New York State. The overall LRI hospitalization rate for New York's 62 counties was 27.0 per 1000 child-years and ranged, among the 18 most populous counties, from 10.7 for Monroe County to 39.3 for the Bronx. Unemployment rate was the strongest predictor of LRI hospitalization rates for counties, explaining 29% of the variance in multiple regression analysis. Within Monroe County, LRI hospitalization rates followed a geographic gradient from the inner city (22.5) to the rest of the city (12.2), and to the suburbs (7.3). Deaths from LRI were uncommon (0.36% of state LRI hospitalizations) and varied little between inner city (0.42%) and suburbs (0.51%). If LRI hospitalization rates for Monroe County suburban children prevailed for the entire state, 10,439 hospitalizations and $32,916,000 would be saved annually.
A large portion of the increased cost of health care for children living in poverty is attributable to hospitalization for LRI in infants. Physician discretion in decision making and factors associated with socioeconomic status are probably major determinants of variation. Well-coordinated follow-up of acute illness visits, home monitoring by visiting nurses, and empirically based clinical guidelines for management of LRI might yield both substantial cost savings and better service to families.
下呼吸道疾病（LRI）是儿童期最常见的严重疾病，也是新生儿期后婴儿住院的最常见原因。本研究评估了降低LRI住院率可能节省的费用。
研究了1985年至1991年纽约州62个县以及门罗县（罗切斯特）内六个社会经济区域1至2岁儿童（婴儿）的LRI住院率。
小区域差异分析。
LRI占纽约州婴儿住院病例的51.2%。纽约州62个县的LRI总体住院率为每1000儿童年27.0例，在18个人口最多的县中，从门罗县的10.7例到布朗克斯的39.3例不等。失业率是各县LRI住院率的最强预测因素，在多元回归分析中解释了29%的方差。在门罗县内，LRI住院率呈现从市中心（22.5）到城市其他地区（12.2）再到郊区（7.3）的地理梯度。LRI死亡并不常见（占该州LRI住院病例的0.36%），市中心（0.42%）和郊区（0.51%）之间差异不大。如果门罗县郊区儿童的LRI住院率适用于整个州，每年将节省10439例住院病例和32916000美元。
贫困儿童医疗保健费用增加的很大一部分归因于婴儿LRI住院。医生决策的自由裁量权以及与社会经济地位相关的因素可能是差异的主要决定因素。对急性病就诊进行良好协调的随访、访视护士的家庭监测以及基于经验的LRI管理临床指南可能会大幅节省成本并为家庭提供更好的服务。
