Predicting Health Care Utilization for Children With Respiratory Insufficiency Using Parent-Proxy Ratings of Children's Health-Related Quality of Life

J Pediatr Health Care. 2017 Nov-Dec;31(6):654-662. doi: 10.1016/j.pedhc.2017.04.021. Epub 2017 Jun 16.

Abstract

Introduction: Children with chronic respiratory insufficiency and mechanical ventilation often experience acute illnesses requiring unscheduled hospitalizations. Health-related quality of life (HRQL) may predict future health care utilization.

Methods: Participants were 30 days to 22 years old with chronic respiratory insufficiency (N = 120). Parent-proxies completed global HRQL and general health measures. Outcomes were total health care (emergency department, outpatient, inpatient) and inpatient days over 6 months. Adjusted negative binomial regression estimated the effects of global HRQL and general health on utilization.

Results: Three quarters of children had any utilization; 32% had hospitalizations. Children with poor/fair global HRQL had 3.7 times more health care days than those with very good/excellent global HRQL. Children with poor/fair global HRQL had 6.3 times more inpatient days than those with very good/excellent global HRQL. Similar relationships existed between general health and utilization.

Discussion: HRQL was associated with health care and inpatient days. Clinical teams can use HRQL as a marker for utilization risk, enabling potentially earlier intervention, better outcomes, and lower costs.

Keywords: Chronic respiratory insufficiency; health care utilization; health-related quality of life; pediatrics.

MeSH terms

  • Adolescent
  • Boston
  • Child
  • Child Health Services / economics
  • Child Health Services / statistics & numerical data*
  • Child, Preschool
  • Children with Disabilities / statistics & numerical data
  • Chronic Disease / economics
  • Chronic Disease / therapy
  • Female
  • Health Care Costs
  • Hospitalization* / economics
  • Humans
  • Infant
  • Longitudinal Studies
  • Male
  • Managed Care Programs
  • Parents*
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Proxy*
  • Quality of Life*
  • Respiration, Artificial / economics
  • Respiration, Artificial / statistics & numerical data*
  • Respiratory Insufficiency / economics
  • Respiratory Insufficiency / therapy*
  • Young Adult