Jay G Berry1, Laurie Glader2, Richard D Stevenson3, Fareesa Hasan4, Charis Crofton5, Kinza Hussain6, Matt Hall7. 1. Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: jay.berry@childrens.harvard.edu. 2. Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA. 3. Division of Developmental Pediatrics, University of Virginia School of Medicine, Charlottesville, VA. 4. Division of Graduate Medical Sciences, Boston University School of Medicine, Boston, MA; Boston University School of Public Health, Boston, MA. 5. Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA. 6. Massachusetts College of Pharmacy and Health Sciences, Boston, MA. 7. Children's Hospital Association, Lenexa, KS.
Abstract
OBJECTIVE: To determine which coexisting conditions have the strongest associations with healthcare use and spending among children with cerebral palsy (CP). STUDY DESIGN: Retrospective analysis of 16 695 children ages 0-18 years with CP - identified with International Classification of Diseases, Ninth Revision, Clinical Modification codes - using Medicaid from January 1, 2013 to December 31, 2013 from 10 states in the Truven MarketScan Medicaid Database. Using generalized linear models, we assessed which coexisting conditions (including medical technology) identified with Agency for Healthcare Research and Quality's Chronic Condition Indicators had the strongest associations with total healthcare spending across the healthcare continuum. RESULTS: Median per-patient annual Medicaid spending for children with CP was $12 299 (IQR $4826-$35 582). Most spending went to specialty (33.1%) and hospital (26.7%) care. The children had a median 6 (IQR 4-10) coexisting conditions; epilepsy was the most common (38.1%). Children with epilepsy accounted for 59.6% ($364 million) of all CP spending. In multivariable analysis, the coexisting conditions most strongly associated with increased spending were tracheostomy (median additional cost per patient = $56 567 [95%CI $51 386-61 748]) and enterostomy (median additional cost per patient = $25 707 [95%CI $23 753-27 660]). CONCLUSIONS: Highly prevalent in children with CP using Medicaid, coexisting conditions correlate strongly with healthcare spending. Tracheostomy and enterostomy, which indicate significant functional impairments in breathing and digestion, are associated with the highest spending. Families, providers, payers, and legislators may leverage these findings when designing policies positioned to enable the best health and care for children with cerebral palsy.
OBJECTIVE: To determine which coexisting conditions have the strongest associations with healthcare use and spending among children with cerebral palsy (CP). STUDY DESIGN: Retrospective analysis of 16 695 children ages 0-18 years with CP - identified with International Classification of Diseases, Ninth Revision, Clinical Modification codes - using Medicaid from January 1, 2013 to December 31, 2013 from 10 states in the Truven MarketScan Medicaid Database. Using generalized linear models, we assessed which coexisting conditions (including medical technology) identified with Agency for Healthcare Research and Quality's Chronic Condition Indicators had the strongest associations with total healthcare spending across the healthcare continuum. RESULTS: Median per-patient annual Medicaid spending for children with CP was $12 299 (IQR $4826-$35 582). Most spending went to specialty (33.1%) and hospital (26.7%) care. The children had a median 6 (IQR 4-10) coexisting conditions; epilepsy was the most common (38.1%). Children with epilepsy accounted for 59.6% ($364 million) of all CP spending. In multivariable analysis, the coexisting conditions most strongly associated with increased spending were tracheostomy (median additional cost per patient = $56 567 [95%CI $51 386-61 748]) and enterostomy (median additional cost per patient = $25 707 [95%CI $23 753-27 660]). CONCLUSIONS: Highly prevalent in children with CP using Medicaid, coexisting conditions correlate strongly with healthcare spending. Tracheostomy and enterostomy, which indicate significant functional impairments in breathing and digestion, are associated with the highest spending. Families, providers, payers, and legislators may leverage these findings when designing policies positioned to enable the best health and care for children with cerebral palsy.
Authors: Catherine Diskin; Kristina Malik; Peter J Gill; Nada Rashid; Carol Y Chan; Katherine E Nelson; Joanna Thomson; Jay Berry; Rishi Agrawal; Julia Orkin; Eyal Cohen Journal: Dev Med Child Neurol Date: 2021-08-30 Impact factor: 4.864
Authors: Joanna Thomson; Matt Hall; Katherine Nelson; Juan Carlos Flores; Brigid Garrity; Danielle D DeCourcey; Rishi Agrawal; Denise M Goodman; James A Feinstein; Ryan J Coller; Eyal Cohen; Dennis Z Kuo; James W Antoon; Amy J Houtrow; Lucia Bastianelli; Jay G Berry Journal: Pediatrics Date: 2021-01-07 Impact factor: 7.124