Shared decision-making and health care expenditures among children with special health care needs.

TitleShared decision-making and health care expenditures among children with special health care needs.
Publication TypeJournal Article
Year of Publication2012
AuthorsFiks AG, Mayne SL, A Localio R, Alessandrini EA, Guevara JP
JournalPediatrics
Volume129
Issue1
Pagination99-107
Date Published2012 Jan
ISSN1098-4275
KeywordsAdolescent, Child, Child Health Services, Child, Preschool, Decision Making, Disabled Children, Emergency Service, Hospital, Female, Health Care Costs, Health Expenditures, Health Services Needs and Demand, Hospitalization, Humans, Infant, Male, Professional-Family Relations, Socioeconomic Factors, United States
Abstract

BACKGROUND AND OBJECTIVES: To understand the association between shared decision-making (SDM) and health care expenditures and use among children with special health care needs (CSHCN).

METHODS: We identified CSHCN <18 years in the 2002-2006 Medical Expenditure Panel Survey by using the CSHCN Screener. Outcomes included health care expenditures (total, out-of-pocket, office-based, inpatient, emergency department [ED], and prescription) and utilization (hospitalization, ED and office visit, and prescription rates). The main exposure was the pattern of SDM over the 2 study years (increasing, decreasing, or unchanged high or low). We assessed the impact of these patterns on the change in expenditures and utilization over the 2 study years.

RESULTS: Among 2858 subjects representing 12 million CSHCN, 15.9% had increasing, 15.2% decreasing, 51.9% unchanged high, and 17.0% unchanged low SDM. At baseline, mean per child total expenditures were $2131. Over the 2 study years, increasing SDM was associated with a decrease of $339 (95% confidence interval: $21, $660) in total health care costs. Rates of hospitalization and ED visits declined by 4.0 (0.1, 7.9) and 11.3 (4.3, 18.3) per 100 CSHCN, and office visits by 1.2 (0.3, 2.0) per child with increasing SDM. Relative to decreasing SDM, increasing SDM was associated with significantly lower total and out-of-pocket costs, and fewer office visits.

CONCLUSIONS: We found that increasing SDM was associated with decreased utilization and expenditures for CSHCN. Prospective study is warranted to confirm if fostering SDM reduces the costs of caring for CSHCN for the health system and families.

DOI10.1542/peds.2011-1352
Alternate JournalPediatrics
PubMed ID22184653
PubMed Central IDPMC3255469
Grant ListK23HD059919 / HD / NICHD NIH HHS / United States