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Determinants of Hospital-Based Health Service Utilization in Cerebral Palsy: a Systematic Review
Simon Paget1, Katarina Ostojic2, Shona Goldsmith2
1Faculty of Medicine and Health, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia; Kids Rehab, the Children's Hospital at Westmead, Westmead NSW, Australia.
Insights
Hospital service use in cerebral palsy (CP) is linked to age, disability severity, and comorbidities. Understanding these factors can improve healthcare access for individuals with CP.
Area of Science:
- Health Services Research
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Individuals with cerebral palsy (CP) often require significant healthcare resources.
- Understanding factors influencing hospital service utilization is crucial for effective healthcare planning and delivery for this population.
Purpose of the Study:
- To systematically review and synthesize evidence on determinants associated with hospital-based health service utilization among individuals with CP.
- To identify key factors influencing inpatient, outpatient, and emergency department use in people with CP.
Main Methods:
- A systematic review of observational studies published between January 2000 and April 2020 was conducted.
- Studies were identified through searches of MEDLINE, Embase, and APA Psycinfo databases.
- Data extraction and risk of bias assessment were performed, with determinants categorized using the Andersen behavioral model.
Main Results:
- Seventeen studies met the inclusion criteria, reporting on 26 determinants of health service utilization.
- Age and indicators of individual need, such as severe motor disability, epilepsy, intellectual disability, and gastrostomy use, were associated with increased hospital service utilization.
- No significant association was found between sex and health service utilization; however, inpatient admissions decreased with age during childhood and were lower in adults.
Conclusions:
- Hospital service utilization in individuals with CP is influenced by age, severity of disability, and the presence of comorbidities.
- Further research is needed to explore socio-demographic and health system contextual determinants.
- Improved understanding of these determinants can enhance healthcare access and service delivery for people with CP.
Objective:
To systematically review and synthesize evidence of determinants associated with hospital-based health service utilization among individuals with cerebral palsy (CP).
Data Sources:
Electronic databases MEDLINE, Embase, APA Psycinfo were searched from January 2000 to April 2020.
Study Selection:
Observational studies were included that described people with CP, reported quantitative measures of hospital-based health service utilization (inpatient, outpatient, emergency department), and based in high-income countries. We excluded studies that included only subsets of people with CP, or those that only reported therapy service utilization.
Data Extraction:
After initial screen, 2 reviewers reviewed full texts for inclusion and performed data extraction and risk of bias assessment using the Newcastle-Ottawa scale. Determinants of health service utilization were identified and categorized using the Andersen behavioral model.
Data Synthesis:
Seventeen studies met inclusion criteria. Study quality was high. Twenty-six determinants were reported across 8 Andersen model characteristics. Individual predisposing factors such as sex showed no difference in health service utilization; inpatient admissions decreased with increasing age during childhood and was lower in adults. Increased health service utilization was associated with "individual need" including severe gross motor disability, epilepsy, developmental/ intellectual disability and gastrostomy-use across inpatient, outpatient and emergency department settings. There was little information reported on socio-demographic and health system contextual determinants.
Conclusions:
CP health service utilization is associated with age, severity and comorbidities. Improved understanding of determinants of health service utilization can support health service access for people with CP.
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