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July 1991, Vol 145, No. 7 >
Article | July 1991

Home Care Cost-effectiveness for Respiratory Technology—Dependent Children FREE

Alan I. Fields, MD; Alan Rosenblatt, MBA; Murray M. Pollack, MD; Joanne Kaufman, RN, MS
[+] Author Affiliations

Accepted for publication January 24, 1991.

Presented in part at the 18th Annual Society of Critical Care Medicine Educational and Scientific Symposium, New Orleans, La, May 8, 1989.

Reprint requests to the Department of Critical Care Medicine, Children's National Medical Center, 111 Michigan Ave NW, Washington, DC 20010 (Dr Fields).


Am J Dis Child. 1991;145(7):727-728. doi:10.1001/archpedi.1991.02160070025016.
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References
Comments

• We evaluated home care costs and the cost-effectiveness of home care vs alternative institutional care for respiratory technology—dependent children in a Medicaid Model Waiver Program. "Cost-savings" was measured as the difference between the established Medicaid reimbursable charges to enact an individualized care plan at a long-term care institution and the actual Medicaid reimbursements for home care. Ten patients—six dependent on mechanical ventilation and four with a tracheostomy who were receiving oxygen—were included in the analysis. The mean (±SD) annual home care costs were $109 836±$20 781 for ventilator-dependent children and $63 650±12 350 for oxygen-dependent patients with a tracheostomy, representing annual savings of approximately $79 000 per patient and $83 000 per patient, respectively. The largest portion of home care reimbursements was for nursing care, accounting for 69.0% and 59.0% of the two patient groups. The full program (50 patients) has the potential for a savings of $4 million per year.

(AJDC. 1991;145:729-733)

REFERENCES

1 +
Burr BH, Guyer B, Todres ID, Abrahams B, Chiodo T.  Home care for children on respirators . N Engl J Med . 1983;;309:1319-1323.
2 +
Frates RC, Splaingard ML, Harrison GM.  Outcome of home mechanical ventilation for children . J Pediatr . 1985;;106:850-856.
3 +
Goldberg AI, Faure EAM, Vaughn CJ, Snarski R, Seleny FL.  Home care for life-supported persons: an approach to program development . J Pediatr . 1984;;104:785-795.
4 +
Thilo EH, Comito J, McCulliss D.  Home oxygen therapy in the newborn: costs and parental acceptance . AJDC . 1987;;141:766-768.
5 +
Eigen H, Zander J.  Home mechanical ventilation of pediatric patients: American Thoracic Society . Am Rev Respir Dis . 1990;;141:258-259.
6 +
The Omnibus Budget Reconciliation Act of 1981 (OBRA). Pub L No. 97-35, Section 2176, 95 Stat 351.
7 +
US Congress, Office of Technology Assessment, Health Program. Technology-Dependent Children: Hospital v Home Care—A Technical Memorandum . Washington, DC: US Government Printing Office; (May) 1987;. OTA-TM-H-38.
8 +
 COMAR 10.09.27 Home care for disabled children under a Model Waiver . Maryland Register . 1985;;12:1041-1045.
9 +
Weinstein MC, Stason WB.  Foundations of cost-effectiveness analysis for health and medical practices . N Engl J Med . 1977;;296:716-721.
10 +
Doubilet P, Weinstein MC, McNeil BJ.  Use and misuse of the term 'cost-effective' in medicine . N Engl J Med . 1986;;314:253-256.
11 +
Aday LA, Aitken MJ, Wegener DH. Pediatric Home Care: Results of a National Evaluation of Programs for Ventilator Assisted Children . Chicago, Ill: Pluribus Press Inc; 1988;.
12 +
Frates RC, Harrison GM, Splaingard ML.  Home care for children on respirators . N Engl J Med . 1984;;310:1126-1127.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Burr BH, Guyer B, Todres ID, Abrahams B, Chiodo T.  Home care for children on respirators . N Engl J Med . 1983;;309:1319-1323.
2 +
Frates RC, Splaingard ML, Harrison GM.  Outcome of home mechanical ventilation for children . J Pediatr . 1985;;106:850-856.
3 +
Goldberg AI, Faure EAM, Vaughn CJ, Snarski R, Seleny FL.  Home care for life-supported persons: an approach to program development . J Pediatr . 1984;;104:785-795.
4 +
Thilo EH, Comito J, McCulliss D.  Home oxygen therapy in the newborn: costs and parental acceptance . AJDC . 1987;;141:766-768.
5 +
Eigen H, Zander J.  Home mechanical ventilation of pediatric patients: American Thoracic Society . Am Rev Respir Dis . 1990;;141:258-259.
6 +
The Omnibus Budget Reconciliation Act of 1981 (OBRA). Pub L No. 97-35, Section 2176, 95 Stat 351.
7 +
US Congress, Office of Technology Assessment, Health Program. Technology-Dependent Children: Hospital v Home Care—A Technical Memorandum . Washington, DC: US Government Printing Office; (May) 1987;. OTA-TM-H-38.
8 +
 COMAR 10.09.27 Home care for disabled children under a Model Waiver . Maryland Register . 1985;;12:1041-1045.
9 +
Weinstein MC, Stason WB.  Foundations of cost-effectiveness analysis for health and medical practices . N Engl J Med . 1977;;296:716-721.
10 +
Doubilet P, Weinstein MC, McNeil BJ.  Use and misuse of the term 'cost-effective' in medicine . N Engl J Med . 1986;;314:253-256.
11 +
Aday LA, Aitken MJ, Wegener DH. Pediatric Home Care: Results of a National Evaluation of Programs for Ventilator Assisted Children . Chicago, Ill: Pluribus Press Inc; 1988;.
12 +
Frates RC, Harrison GM, Splaingard ML.  Home care for children on respirators . N Engl J Med . 1984;;310:1126-1127.

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