Home Health Care Utilization in Children With Medicaid.
Journal
Pediatrics
ISSN: 1098-4275
Titre abrégé: Pediatrics
Pays: United States
ID NLM: 0376422
Informations de publication
Date de publication:
01 02 2022
01 02 2022
Historique:
pubmed:
15
1
2022
medline:
22
2
2022
entrez:
14
1
2022
Statut:
ppublish
Résumé
Although many children with medical complexity (CMC) use home health care (HHC), little is known about all pediatric HHC utilizers. Our objective was to assess characteristics of pediatric HHC recipients, providers, and payments. We conducted a retrospective analysis of 5 209 525 children age 0-to-17 years enrolled Medicaid in the 2016 IBM Watson MarketScan Medicaid Database. HHC utilizers had ≥ 1 HHC claim. Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes were reviewed to codify provider types when possible: registered nurse (RN), licensed practical nurse (LPN), home health aide (HHA), certified nursing assistant (CNA), or companion/personal attendant. Enrollee clinical characteristics, HHC provider type, and payments were assessed. Chronic conditions were evaluated with Agency for Healthcare Research and Quality's Chronic Condition Indicators and Feudtner's Complex Chronic Conditions. Of the 0.8% of children who used HHC, 43.8% were age <1 year, 25% had no chronic condition, 38.6% had a noncomplex chronic condition, 21.5% had a complex chronic condition without technology assistance, and 15.5% had technology assistance (eg, tracheostomy). HHC for children with technology assistance accounted for 72.6% of all HHC spending. Forty-five percent of HHC utilizers received RN/LPN-level care, 7.9% companion/personal attendant care, 5.9% HHA/CNA-level care, and 36% received care from an unspecified provider. For children with technology assistance, the majority (77.2%) received RN/LPN care, 17.5% companion/personal assistant care, and 13.8% HHA/CNA care. Children using HHC are a heterogeneous population who receive it from a variety of providers. Future investigations should explore the role of nonnurse caregivers, particularly with CMC.
Sections du résumé
BACKGROUND
Although many children with medical complexity (CMC) use home health care (HHC), little is known about all pediatric HHC utilizers. Our objective was to assess characteristics of pediatric HHC recipients, providers, and payments.
METHODS
We conducted a retrospective analysis of 5 209 525 children age 0-to-17 years enrolled Medicaid in the 2016 IBM Watson MarketScan Medicaid Database. HHC utilizers had ≥ 1 HHC claim. Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes were reviewed to codify provider types when possible: registered nurse (RN), licensed practical nurse (LPN), home health aide (HHA), certified nursing assistant (CNA), or companion/personal attendant. Enrollee clinical characteristics, HHC provider type, and payments were assessed. Chronic conditions were evaluated with Agency for Healthcare Research and Quality's Chronic Condition Indicators and Feudtner's Complex Chronic Conditions.
RESULTS
Of the 0.8% of children who used HHC, 43.8% were age <1 year, 25% had no chronic condition, 38.6% had a noncomplex chronic condition, 21.5% had a complex chronic condition without technology assistance, and 15.5% had technology assistance (eg, tracheostomy). HHC for children with technology assistance accounted for 72.6% of all HHC spending. Forty-five percent of HHC utilizers received RN/LPN-level care, 7.9% companion/personal attendant care, 5.9% HHA/CNA-level care, and 36% received care from an unspecified provider. For children with technology assistance, the majority (77.2%) received RN/LPN care, 17.5% companion/personal assistant care, and 13.8% HHA/CNA care.
CONCLUSIONS
Children using HHC are a heterogeneous population who receive it from a variety of providers. Future investigations should explore the role of nonnurse caregivers, particularly with CMC.
Identifiants
pubmed: 35028664
pii: 184489
doi: 10.1542/peds.2021-050534
pmc: PMC9003864
mid: NIHMS1783672
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NICHD NIH HHS
ID : K23 HD097276
Pays : United States
Informations de copyright
Copyright © 2022 by the American Academy of Pediatrics.
Déclaration de conflit d'intérêts
CONFLICT OF INTEREST DISCLOSURES: The authors have indicated they have no conflicts of interest relevant to this article to disclose.
Références
J Pediatr. 2016 May;172:187-193.e1
pubmed: 26897040
Pediatr Pulmonol. 2015 Jul;50(7):691-7
pubmed: 24706404
J Pediatr. 2018 Sep;200:111-117.e1
pubmed: 29752173
Pediatrics. 2012 Dec;130(6):e1463-70
pubmed: 23184117
Pediatrics. 2009 Aug;124(2):563-72
pubmed: 19596736
Am J Dis Child. 1991 Jul;145(7):729-33
pubmed: 1905479
Health Aff (Millwood). 2014 Dec;33(12):2199-206
pubmed: 25489039
Hosp Pediatr. 2017 Jul;7(7):365-372
pubmed: 28634168
Health Aff (Millwood). 2009 Jan-Feb;28(1):262-72
pubmed: 19124878
Pediatrics. 2007 Oct;120(4):e832-45
pubmed: 17908740
Home Healthc Now. 2020 Mar/Apr;38(2):75-79
pubmed: 32134814
Child Care Health Dev. 2017 May;43(3):323-333
pubmed: 27896838
J Child Health Care. 2013 Jun;17(2):153-63
pubmed: 23711491
Child Care Health Dev. 2007 Mar;33(2):180-7
pubmed: 17291322
Pediatrics. 2020 Aug;146(2):
pubmed: 32641356
J Adv Nurs. 2005 Sep;51(5):456-64
pubmed: 16098162
J Hosp Palliat Nurs. 2018 Jun;20(3):260-265
pubmed: 29910692
Med Care Res Rev. 2015 Oct;72(5):622-40
pubmed: 26062611
Pediatrics. 2016 Oct;138(4):
pubmed: 27633920
Scand J Caring Sci. 2017 Mar;31(1):27-36
pubmed: 27126367
BMC Health Serv Res. 2011 Jul 04;11:156
pubmed: 21726441
JAMA Pediatr. 2016 Apr;170(4):326-33
pubmed: 26902773
J Pediatr. 2019 Sep;212:166-171
pubmed: 31153586
Pediatrics. 2016 Nov;138(5):
pubmed: 27940764
Ann Am Thorac Soc. 2013 Oct;10(5):482-9
pubmed: 23987826
Arch Pediatr Adolesc Med. 2011 Nov;165(11):1020-6
pubmed: 22065182
J Dev Behav Pediatr. 2015 Jun;36(5):352-61
pubmed: 25933227
Pediatrics. 2012 May;129(5):996-1005
pubmed: 22547780
Neurosurgery. 2009 Jun 1;64(6):E1206
pubmed: 28173253
Pediatrics. 2014 Oct;134(4):836-46
pubmed: 25266436
Pediatr Pulmonol. 2018 Jan;53(1):108-116
pubmed: 29152895
J Pediatr. 2017 Mar;182:267-274
pubmed: 27979584
Pediatrics. 2017 Mar;139(3):
pubmed: 28242864
Clin Pediatr (Phila). 2020 Feb;59(2):178-187
pubmed: 31849237
Adv Neonatal Care. 2017 Aug;17(4):258-264
pubmed: 28252522
Pediatr Pulmonol. 2020 Jun;55(6):1474-1480
pubmed: 32212321
J Pediatr. 2019 Sep;212:10-12
pubmed: 31277899
Hosp Pediatr. 2020 Aug;10(8):663-669
pubmed: 32718915
BMC Pediatr. 2014 Aug 08;14:199
pubmed: 25102958
J Pediatr. 2019 Apr;207:169-175.e2
pubmed: 30612815
Health Aff (Millwood). 2019 Jun;38(6):987-993
pubmed: 31158008
Anesth Analg. 2019 Oct;129(4):1175-1180
pubmed: 30489312
Pediatrics. 2019 Jan;143(1):
pubmed: 30509929
Nurs Res. 1999 May-Jun;48(3):129-40
pubmed: 10337844
Disabil Health J. 2013 Oct;6(4):317-24
pubmed: 24060254
Acad Pediatr. 2017 Aug;17(6):665-671
pubmed: 28450083