Riley A W, Finney J W, Mellits E D, Starfield B, Kidwell S, Quaskey S, Cataldo M F, Filipp L, Shematek J P
Johns Hopkins University, Department of Health Policy and Management, Baltimore, MD 21205-1995.
Med Care. 1993 Sep;31(9):767-83. doi: 10.1097/00005650-199309000-00002.
Factors related to the amount of health care used by 5- to 11-year-old children in a health maintenance organization (HMO) were investigated using a comprehensive multivariate model that assessed the contribution of child health need, mental health, and social functioning; maternal mental health, social support and health care utilization; and family functioning and life events. Mothers reported on the 450 participating children. Health care visits for a two-year retrospective period were obtained from the computerized encounter system. Child health need and maternal patterns of health care use were powerful predictors of the overall amount of health care used, and these factors discriminated high users from low users of care. Family conflict was associated with a higher volume of care, while children's depressive symptoms and non-white race were related to lower use. Maternal social support, mental health, and life events were not predictive of use in either full multivariate model. Enabling factors were held relatively constant by participation of all families in a prepaid HMO. The multiple regression model explained 33% of the variance in use, slightly more than in previous studies of children's health care use. When included in a comprehensive analysis, child and family psychosocial characteristics help to explain children's health care use beyond what is possible using simple health and illness variables. The implications of these findings in the development of further research and to the practice of routine pediatric care are discussed.
利用一个综合多变量模型，对健康维护组织（HMO）中5至11岁儿童使用的医疗保健量相关因素进行了调查，该模型评估了儿童健康需求、心理健康和社会功能；母亲的心理健康、社会支持和医疗保健利用情况；以及家庭功能和生活事件的作用。母亲们报告了450名参与研究的儿童情况。通过计算机化的诊疗系统获取了为期两年的回顾期内的医疗就诊记录。儿童健康需求和母亲的医疗保健使用模式是所使用医疗保健总量的有力预测因素，这些因素区分了高医疗使用者和低医疗使用者。家庭冲突与更高的医疗量相关，而儿童的抑郁症状和非白人种族则与较低的医疗使用量有关。在两个完整的多变量模型中，母亲的社会支持、心理健康和生活事件均不能预测医疗使用情况。由于所有家庭都参与了预付式健康维护组织，促成因素相对保持不变。多元回归模型解释了医疗使用量中33%的方差，略高于之前关于儿童医疗保健使用情况的研究。当纳入综合分析时，儿童和家庭的心理社会特征有助于解释儿童的医疗保健使用情况，这超出了仅使用简单的健康和疾病变量所能解释的范围。讨论了这些研究结果对进一步研究发展和常规儿科护理实践的意义。
