Long-Term Health Care Utilization After Cardiac Surgery in Children Covered Under Medicaid

Sarah Crook; Kacie Dragan; Joyce L Woo; Matthew Neidell; Pengfei Jiang; Stephen Cook; Edward L Hannan; Jane W Newburger; Marshall L Jacobs; Emile A Bacha; Christopher J Petit; Robert Vincent; Kathleen Walsh-Spoonhower; Ralph Mosca; T K Susheel Kumar; Neil Devejian; Steven A Kamenir; George M Alfieris; Michael F Swartz; David Meyer; Erin A Paul; John Billings; Brett R Anderson; New York State CHS-COLOUR

doi:10.1016/j.jacc.2023.02.021

Long-Term Health Care Utilization After Cardiac Surgery in Children Covered Under Medicaid

J Am Coll Cardiol. 2023 Apr 25;81(16):1605-1617. doi: 10.1016/j.jacc.2023.02.021.

Authors

Sarah Crook¹, Kacie Dragan², Joyce L Woo³, Matthew Neidell⁴, Pengfei Jiang¹, Stephen Cook⁵, Edward L Hannan⁶, Jane W Newburger⁷, Marshall L Jacobs⁸, Emile A Bacha⁹, Christopher J Petit¹, Robert Vincent¹⁰, Kathleen Walsh-Spoonhower¹¹, Ralph Mosca¹², T K Susheel Kumar¹², Neil Devejian¹³, Steven A Kamenir¹⁴, George M Alfieris¹⁵, Michael F Swartz¹⁶, David Meyer¹⁷, Erin A Paul¹⁸, John Billings¹⁹, Brett R Anderson²⁰; New York State CHS-COLOUR

Affiliations

¹ Division of Pediatric Cardiology; NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.
² New York University, Wagner Graduate School of Public Service, New York, New York, USA; Interfaculty Initiative in Health Policy, Harvard University, Cambridge, Massachusetts, USA.
³ Division of Pediatric Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
⁴ Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, USA.
⁵ Department of Pediatrics, Internal Medicine, and Center for Community Health, University of Rochester Medical Center, Rochester, New York, USA; New York State Department of Health, Offices of Health Insurance Programs, Albany, New York, USA.
⁶ University at Albany School of Public Health, Rensselaer, New York, USA.
⁷ Department of Pediatric Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.
⁸ Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁹ Department of Cardiothoracic Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center and Weill Cornell Medical Center, New York, New York, USA.
¹⁰ Division of Pediatric Cardiology, Westchester Medical Center, Valhalla, New York, USA.
¹¹ Division of Pediatric Cardiology, Stony Brook Children's Hospital, Stony Brook, New York, USA.
¹² Department of Cardiothoracic Surgery, New York University, New York, New York, USA.
¹³ Division of Pediatric Cardiothoracic Surgery, Albany Medical College, Albany, New York, USA.
¹⁴ Division of Pediatric Cardiology, Albany Medical College, Albany, New York, USA.
¹⁵ Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York, USA; Department of Surgery, State University of New York Upstate Medical Center, Syracuse, New York, USA.
¹⁶ Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York, USA.
¹⁷ Departments of Cardiothoracic Surgery and Pediatrics, Hofstra-Northwell School of Medicine, Uniondale, New York, USA.
¹⁸ Division of Pediatric Cardiology, Icahn School of Medicine at Mt. Sinai, New York, New York, USA.
¹⁹ New York University, Wagner Graduate School of Public Service, New York, New York, USA.
²⁰ Division of Pediatric Cardiology; NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA. Electronic address: bra2113@cumc.columbia.edu.

PMID: 37076215
DOI: 10.1016/j.jacc.2023.02.021

Abstract

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.

Keywords: Medicaid; children; expenditures; health care utilization; longitudinal.

Publication types

Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

MeSH terms

Adolescent
Cardiac Surgical Procedures*
Child
Health Expenditures
Humans
Medicaid*
New York
Patient Acceptance of Health Care
United States / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding