Cavalier S, Escobar G J, Fernbach S A, Quesenberry C P, Chellino M
Department of Pediatrics, Kaiser Permanente Medical Center, Walnut Creek, California, USA.
Pediatrics. 1996 May;97(5):693-9.
Infants discharged from intensive care nurseries are a high-risk infant (HRI) population known to have increased utilization of medical services. Most studies tracking HRIs have been based on data obtained from individual chart review or direct patient contact. Given the high cost of such studies, it is desirable to develop less costly methods to track such infants.
Our goals were: (1) to identify an HRI cohort at two neonatal intensive care units; (2) to identify a control group of infants not meeting HRI criteria; and (3) to measure outpatient and inpatient utilization in both controls using computerized files in a managed care organization.
Using California Children's Services criteria as our starting point, we established an HRI definition. From a 1-year birth cohort of 7579 infants at two facilities, we identified 250 infants meeting the HRI definition at two neonatal intensive care units during 1990. We then matched the HRIs with a cohort of 896 randomly selected control newborns (those not meeting the HRI definition). Using organizational computer files and state of California death certificate tapes, we followed these infants until February 28, 1992. We measured the number of hospitalizations, total number of hospital days, and total number of outpatient visits and expressed these outcomes as rates per person-year. We also measured postdischarge mortality.
The rate of hospitalization in the HRI group was 6.07 times (95% confidence interval [CI], 4.74-7.77) that in the control group. The utilization of hospital days by the HRI population (hospital days per 1000 person-months) was 13.24 times higher (95% CI, 11.00-16.04). The outpatient visit rate was 1.40 times higher (95% CI, 1.36-1.45) in the HRI population.
Our findings in a large managed care organization corroborate previous studies showing that hospitalization rates are significantly higher among HRIs. In our study population, outpatient utilization was significantly higher as well. Our study also demonstrates the feasibility of using computerized files to study outcomes in selected pediatric populations. These methods can be used for epidemiologic studies, interventional trials, and planning for resource allocation.
从重症监护病房出院的婴儿属于高危婴儿群体，其医疗服务利用率较高。大多数追踪高危婴儿的研究都是基于从个体病历审查或直接患者接触中获取的数据。鉴于此类研究成本高昂，开发成本较低的方法来追踪这些婴儿是很有必要的。
我们的目标是：（1）在两个新生儿重症监护病房确定一个高危婴儿队列；（2）确定一组不符合高危婴儿标准的婴儿作为对照组；（3）使用管理式医疗组织中的计算机文件来衡量两组婴儿的门诊和住院利用率。
以加利福尼亚儿童服务标准为出发点，我们制定了高危婴儿的定义。从两个机构的7579名婴儿的1年出生队列中，我们确定了1990年期间在两个新生儿重症监护病房符合高危婴儿定义的250名婴儿。然后，我们将这些高危婴儿与896名随机选择的对照新生儿（不符合高危婴儿定义的婴儿）进行匹配。利用组织计算机文件和加利福尼亚州死亡证明磁带，我们对这些婴儿进行追踪，直至1992年2月28日。我们测量了住院次数、住院总天数和门诊就诊总次数，并将这些结果表示为人年率。我们还测量了出院后死亡率。
高危婴儿组的住院率是对照组的6.07倍（95%置信区间[CI]，4.74 - 7.77）。高危婴儿群体的住院天数利用率（每1000人月的住院天数）高出13.24倍（95%CI，11.00 - 16.04）。高危婴儿群体的门诊就诊率高出1.40倍（95%CI，1.36 - 1.45）。
我们在一个大型管理式医疗组织中的研究结果证实了先前的研究，即高危婴儿的住院率显著更高。在我们的研究人群中，门诊利用率也显著更高。我们的研究还证明了使用计算机文件来研究特定儿科人群结局的可行性。这些方法可用于流行病学研究、干预试验和资源分配规划。
