Categorization of a Universal Coding System to Distinguish Use of Durable Medical Equipment and Supplies in Pediatric Patients.

Autor:	Hotz A; Complex Care, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts., Sprecher E; Complex Care, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts., Bastianelli L; Cerebral Palsy and Spasticity Center, Boston Children's Hospital, Boston, Massachusetts., Rodean J; Children's Hospital Association, Lenexa, Kansas., Stringfellow I; Complex Care, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts., Barkoudah E; Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.; Department of Neurology, Harvard Medical School, Boston, Massachusetts., Cohen LE; Division of Pediatric Endocrinology & Diabetes, The Children's Hospital at Montefiore, Bronx, New York.; Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York., Estrada C; Department of Urology, Boston Children's Hospital, Boston, Massachusetts.; Department of Surgery, Harvard Medical School, Boston, Massachusetts., Graham R; Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.; Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts., Greenwood J; Department of Physical Therapy and Occupational Therapy Services, Boston Children's Hospital, Boston, Massachusetts., Kyle J; UnitedHealthcare, Minneapolis, Minnesota., Mann N; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.; Division of Nephrology, Boston Children's Hospital, Boston, Massachusetts., Pinkham M; Department of Physical Therapy and Occupational Therapy Services, Boston Children's Hospital, Boston, Massachusetts., Solari T; Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts., Rosen R; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.; Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts., Saleeb S; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.; Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts., Shah AS; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts.; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts., Watters K; Department of Otolaryngology, Boston Children's Hospital, Boston, Massachusetts.; Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts., Wells S; Complex Care, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts., Berry JG; Complex Care, Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2023 Oct 02; Vol. 6 (10), pp. e2339449. Date of Electronic Publication: 2023 Oct 02.
DOI:	10.1001/jamanetworkopen.2023.39449
Abstrakt:	Importance: Although durable medical equipment and supplies (DMES) are commonly used to optimize the health and function in pediatric patients, little is known about the prevalence of use and spending on DMES. Objective: To categorize the Healthcare Common Procedure Coding System (HCPCS) for distinguishing DMES types, and to measure the prevalence and related spending of DMES in pediatric patients using Medicaid. Design, Setting, and Participants: This study is a cross-sectional analysis of the 2018 Merative Medicaid Database and included 4 569 473 pediatric patients aged 0 to 21 years enrolled in Medicaid in 12 US states from January 1 to December 31, 2018. Data were analyzed from February 2019 to April 2023. Exposure: DMES exposure was identified with the Centers for Medicare & Medicaid Services HCPCS codes. Three pediatricians categorized HCPCS DMES codes submitted by vendors for reimbursement of dispensed DMES into DMES types and end-organ systems; 15 expert reviewers refined the categorization (2576 DMES codes, 164 DMES types, 14 organ systems). Main Outcomes and Measures: The main outcome was DMES prevalence & Medicaid spending. The χ2 test was used to compare DMES prevalence and Wilcoxon rank sum tests were used to compare per-member-per-year (PMPY) spending by complex chronic conditions (CCC). Results: Of the 4 569 473 patients in the study cohort, 49.3% were female and 56.1% were aged 5 to 15 years. Patients used 133 of 164 (81.1%) DMES types. The DMES prevalence was 17.1% (95% CI, 17.0%-17.2%) ranging from 10.1% (95% CI, 10.0%-10.2%) in patients with no chronic condition to 60.9% (95% CI, 60.8%-61.0%) for patients with 2 or more CCCs. The PMPY DMES spending was $593, ranging from $349 for no chronic condition to $4253 for 2 or more CCCs. Lens (7.9%), vision frames (6.2%), and orthotics for orthopedic injury (0.8%) were the most common DME in patients with no chronic condition. Enteral tube / feeding supplies (19.8%), diapers (19.2%), lower extremity orthotics (12.3%), wheelchair (9.6%), oxygen (9.0%), and urinary catheter equipment (4.2%) were among the most common DMES in children with 2 or more CCCs. Conclusions and Relevance: In this cross-sectional study, HCPCS distinguished a variety of DME types and use across pediatric populations. Further investigation should assess the utility of the HCPCS DMES categorization with efforts to optimize the quality and safety of DMES use.
Databáze:	MEDLINE
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