Assessing Health Care Utilization and Compliance in Kawasaki Disease
| Autor: | Daniel L. Brinton, Scarlett Carmen Johnson, Annie N. Simpson, Annie Lintzenich Andrews, Daniel C. Williams, Marshall Chew |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Mucocutaneous Lymph Node Syndrome Logistic regression 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Claims data Health care Hospital discharge medicine Ambulatory Care Humans 030212 general & internal medicine Child Retrospective Studies business.industry Infant Newborn Infant Guideline After discharge Patient Acceptance of Health Care medicine.disease United States Hospitalization Logistic Models Echocardiography Child Preschool Pediatrics Perinatology and Child Health Emergency medicine Kawasaki disease Female Health Expenditures business Facilities and Services Utilization Follow-Up Studies |
| Zdroj: | The Journal of pediatrics. 234 |
| ISSN: | 1097-6833 |
| Popis: | To characterize health care utilization and costs associated with care after diagnosis of Kawasaki disease including adherence to guidelines for echocardiograms.We analyzed children hospitalized for Kawasaki disease using 2015-2017 national Truven MarketScan commercial claims data. The mean 90-day prehospitalization utilization and costs were quantified and compared with the 90 days posthospitalization via Wilcoxon 2-sample test. Adherence to echocardiogram guidelines was examined using multivariable logistic regression to identify factors associated with adherence.The mean total payments 90 days prior to hospitalization ($2090; n = 360) were significantly lower than those after discharge ($3778), though out of pocket costs were higher ($400 vs $270) (P .0001). There was an increase in office visits, medical procedures, and echocardiograms after discharge. A majority of health care utilization before hospitalization occurred in the 7 days immediately prior to the date of admission; 51% obtained an echocardiogram within the first 2 weeks, and 14% were completely adherent with recommendations. Children with greater utilization prior to admission were more likely to adhere to American Heart Association guidelines for follow-up echocardiograms (OR 1.03, 95% CI 1.01-1.06).Outpatient health care expenditure nearly doubles after Kawasaki disease hospital discharge when compared with prehospitalization, suggesting the financial ramifications of this diagnosis persist beyond costs incurred during hospitalization. A significant portion of patients do not receive guideline recommended follow-up echocardiograms. This issue should be explored in more detail given the morbidity and mortality associated with this diagnosis. |
| Databáze: | OpenAIRE |
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