Association of Home Respiratory Equipment and Supply Use with Health Care Resource Utilization in Children - 05/01/19

Doi : 10.1016/j.jpeds.2018.11.046

Jay G. Berry, MD, MPH ^1,^* , Denise M. Goodman, MD, MS ², Ryan J. Coller, MD, MPH ³, Rishi Agrawal, MD, MPH ^2,⁴, Dennis Z. Kuo, MD, MHS ⁵, Eyal Cohen, MD ⁶, Joanna Thomson, MD, MPH ⁷, Danielle DeCourcey, MD, MPH ⁸, Neal DeJong, MD, MPH ⁹, Anna Agan, BA ¹, Dipika Gaur, BS, MSc ¹⁰, Madeline Coquillette, MD ¹, Charis Crofton, BA ¹, Amy Houtrow, MD, MPH, PhD ¹¹, Matt Hall, PhD ¹²
¹ Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
² Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
³ Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
⁴ Division of Hospital-Based Medicine, La Rabida Children's Hospital, Chicago, IL
⁵ Department of Pediatrics, John R. Oishei Children's Hospital, University at Buffalo, Buffalo, NY
⁶ Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
⁷ Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
⁸ Division of Medicine Critical Care, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
⁹ Division of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
¹⁰ Rush Medical College, Rush University, Chicago, IL
¹¹ Division of Pediatric Rehabilitation Medicine, University of Pittsburgh School of Medicine, Pittsburg, PA
¹² Children's Hospital Association, Lenexa, KS

^*Reprint requests: Jay G. Berry, MD, MPH, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, 21 Autumn St, Rm 212.2, Boston, MA 02115.Division of General PediatricsBoston Children's HospitalHarvard Medical School21 Autumn StRm 212.2BostonMA02115

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 05 January 2019

Abstract

Objective

To compare health care use and spending in children using vs not using respiratory medical equipment and supplies (RMES).

Study design

Cohort study of 20 352 children age 1-18 years continuously enrolled in Medicaid in 2013 from 12 states in the Truven Medicaid MarketScan Database; 7060 children using RMES were propensity score matched with 13 292 without RMES. Home RMES use was identified with Healthcare Common Procedure Coding System and International Classification of Diseases codes. RMES use was regressed on annual per-member-per-year Medicaid payments, adjusting for demographic and clinical characteristics, including underlying respiratory and other complex chronic conditions.

Results

Of children requiring RMES, 47% used oxygen, 28% suction, 22% noninvasive positive-pressure ventilation, 17% tracheostomy, 8% ventilator, 5% mechanical in-exsufflator, and 4% high-frequency chest wall oscillator. Most children (93%) using RMES had a chronic condition; 26% had ≥6. The median per-member-per-year payments in matched children with vs without RMES were $24 359 vs $13 949 (P < .001). In adjusted analyses, payment increased significantly (P < .001 for all) with mechanical in-exsufflator (+$2657), tracheostomy (+$6447), suction (+$7341), chest wall oscillator (+$8925), and ventilator (+$20 530). Those increased payments were greater than the increase associated with a coded respiratory chronic condition (+$2709). Hospital and home health care were responsible for the greatest differences in payment (+$3799 and +$3320, respectively) between children with and without RMES.

Conclusion

The use of RMES is associated with high health care spending, especially with hospital and home health care. Population health initiatives in children may benefit from consideration of RMES in comprehensive risk assessment for health care spending.

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Keywords : children with medical complexity, health care resource use, respiratory medical equipment and supplies

Abbreviations : CCC, CMC, DME, HCPCS, ICD-9-CM, NIPPV, PMPY, RMES

Plan

Methods

Main Outcome Measures

Demographic and Clinical Characteristics of the Children

Health Care Use and Spending of Children Using vs Not Using RMES

Discussion

Drs. Berry and Hall were supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under UA6MC31101 Children and Youth with Special Health Care Needs Research Network. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. J.T. was supported by the Agency for Healthcare Research and Quality (AHRQ K08 HS02513). D.G. serves as an Associate Editor for The Journal of Pediatrics. The other authors declare no conflicts of interest.