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Prediction of resource use during acute pediatric illnesses
Paul McCarthy1, Theodore Walls, Dominic Cicchetti
1Department of Pediatrics, Yale University School of Medicine, New Haven, Conn 06520, USA. Paul.McCarthy@yale.edu
Insights
Maternal-child interaction quality, parenting confidence, and perceived illness severity predict children's healthcare resource use. Interventions targeting these factors can reduce healthcare costs for acute pediatric illnesses.
Area of Science:
- Pediatric healthcare utilization
- Maternal and child health
- Health services research
Background:
- Acute illnesses in children represent a significant use of healthcare resources.
- Identifying predictors of resource utilization is crucial for developing targeted interventions.
- Understanding factors influencing healthcare resource use can lead to more efficient pediatric care.
Purpose of the Study:
- To investigate the predictors of healthcare resource use during acute childhood illnesses.
- To determine the relative impact of maternal, infant, social, and demographic factors on resource utilization.
- To examine the role of mother-child interaction and perceived illness severity in healthcare resource consumption.
Main Methods:
- A cohort of 243 mother-infant dyads was followed for 30 months.
- Mother-child interaction was assessed using the Biringen Emotional Availability Scales.
- Maternal depression, sense of competence, infant temperament, social support, home environment, demographics, and illness severity were recorded.
- Resource use (medications, tests, hospitalizations, ED visits) was systematically tracked.
- Path analysis using structural equation modeling analyzed predictive relationships.
Main Results:
- Less optimal mother-child interaction, lower parenting sense of competence, and greater maternal perception of illness severity significantly predicted higher mean resource use.
- These three factors accounted for 55% of the variance in resource use during acute pediatric illnesses.
- The quality of mother-child interaction showed the strongest predictive relationship with resource use.
Conclusions:
- Mother-child interaction quality, maternal sense of competence, and maternal perception of illness severity are key predictors of healthcare resource use in acute pediatric illnesses.
- Interventions focusing on improving these factors may effectively reduce healthcare resource utilization.
- These findings highlight the importance of a holistic approach to managing acute childhood illnesses, considering psychosocial and interactional dynamics.
Background:
Significant resources are used for acute illnesses in children. Identifying predictors of resource use can focus interventions to reduce this use.
Objective:
To determine the relative effects of maternal, infant, social milieu, and demographic characteristics, the mother-child interaction, and perception of illness severity on the use of resources during acute illnesses in children.
Design:
At the 2-week and 6-, 15-, and 24-month well-child care visits of a cohort of mother-infant dyads, the mother-well-child interaction was assessed by using the Biringen Emotional Availability Scales, and data were gathered regarding maternal depression and sense of competence, infant temperament, maternal social support, the home environment, and demographic characteristics. At each of the cohort's 1983 ill-child care visits during 30 months of follow-up, the mother-ill-child interaction was assessed by using the Emotional Availability Scales, and mothers and pediatricians independently assessed illness severity using the Acute Illness Observation Scales. Resources used during the illnesses-over-the-counter and prescription medications, tests, hospitalizations, follow-up visits, and the emergency department-were assessed.
Setting:
A hospital primary care center and an urban and a suburban private practice. Patients Between February 1, 1995, and March 30, 1998, a consecutive sample of 380 dyads were asked to enroll at the 2-week well-child care visit; 316 (83.2%) consented, and complete data were available for analysis of 243 dyads.
Main Outcome Measures:
A path analytic framework using a structural equation model assessed the presence and strength of predictive relationships between demographic, maternal, infant, and social milieu data, the Biringen Emotional Availability Scales, and the Acute Illness Observation Scales and the main outcome measure, resource use.
Results:
Three variables predicted greater mean resource use during each acute illness episode: a less optimal mother-child interaction (beta = -.53), lower scores for parenting sense of competence (beta = -.26), and greater perception of illness severity by mothers (beta =.33). By using the coefficient of determination (R2), these 3 predictors account for 55% of the reliable variance in resource use during acute illnesses.
Conclusion:
The quality of the mother-child interaction, maternal sense of competence, and maternal assessment of severity of the illness are major predictors of resource use during acute pediatric illnesses, and should be important foci of interventions to reduce resource use.
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