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Long-Term Health Care Utilization After Cardiac Surgery in Children Covered Under Medicaid
Sarah Crook1, Kacie Dragan2, Joyce L Woo3
1Division of Pediatric Cardiology; NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.
Insights
Pediatric cardiac surgery patients incur higher healthcare costs and utilization than others. Disparities in care exist among racial/ethnic groups, necessitating further investigation into underlying mechanisms.
Area of Science:
- Pediatric cardiology
- Health services research
- Health equity
Background:
- Understanding long-term healthcare costs and utilization after pediatric cardiac surgery is crucial for family counseling, care improvement, and reducing outcome inequities.
- Existing research lacks comprehensive data on the longitudinal financial and service utilization burden for children undergoing cardiac surgery.
Purpose of the Study:
- To describe and identify predictors of healthcare expenditures and utilization in Medicaid-insured pediatric cardiac surgical patients.
- To provide insights for resource allocation and policy development in pediatric cardiac care.
Main Methods:
- A cohort of 5,241 Medicaid-enrolled children (<18 years) undergoing cardiac surgery in New York State (2006-2019) was analyzed using Medicaid claims data.
- A matched cohort of children without cardiac surgical disease was used for comparison.
- Log-linear and Poisson regression models assessed associations between patient characteristics and healthcare expenditures, inpatient stays, primary care, subspecialist visits, and emergency department use.
Main Results:
- Cardiac surgical patients incurred significantly higher monthly healthcare expenditures ($15,500 ± $62,000 in year 1, $1,600 ± $9,100 in year 5) compared to non-surgical comparators ($700 ± $6,600 in year 1, $300 ± $2,200 in year 5).
- Patients spent an average of 52.9 days in healthcare settings in the first year and 90.5 days over five years post-surgery.
- Hispanic children, compared to non-Hispanic White children, had more emergency visits, inpatient admissions, and subspecialist visits, but fewer primary care visits and higher 5-year mortality.
Conclusions:
- Children undergoing cardiac surgery face substantial and ongoing healthcare needs, even with less severe conditions.
- Significant differences in healthcare utilization patterns were observed across racial and ethnic groups.
- Further research is needed to understand and address the mechanisms driving healthcare disparities in this population.
Background:
Understanding the longitudinal burden of health care expenditures and utilization after pediatric cardiac surgery is needed to counsel families, improve care, and reduce outcome inequities.
Objectives:
The purpose of this study was to describe and identify predictors of health care expenditures and utilization for Medicaid-insured pediatric cardiac surgical patients.
Methods:
All Medicaid enrolled children age <18 years undergoing cardiac surgery in the New York State CHS-COLOUR database, from 2006 to 2019, were followed in Medicaid claims data through 2019. A matched cohort of children without cardiac surgical disease was identified as comparators. Expenditures and inpatient, primary care, subspecialist, and emergency department utilization were modeled using log-linear and Poisson regression models to assess associations between patient characteristics and outcomes.
Results:
In 5,241 New York Medicaid-enrolled children, longitudinal health care expenditures and utilization for cardiac surgical patients exceeded noncardiac surgical comparators (cardiac surgical children: $15,500 ± $62,000 per month in year 1 and $1,600 ± $9,100 per month in year 5 vs noncardiac surgical children: $700 ± $6,600 per month in year 1 and $300 ± $2,200 per month in year 5). Children after cardiac surgery spent 52.9 days in hospitals and doctors' offices in the first postoperative year and 90.5 days over 5 years. Being Hispanic, compared with non-Hispanic White, was associated with having more emergency department visits, inpatient admissions, and subspecialist visits in years 2 to 5, but fewer primary care visits and greater 5-year mortality.
Conclusions:
Children after cardiac surgery have significant longitudinal health care needs, even among those with less severe cardiac disease. Health care utilization differed by race/ethnicity, although mechanisms driving disparities should be investigated further.
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