Abstract
BackgroundThe objective of this study was to test the primary hypothesis that parent proxy-report of pediatric health-related quality of life (HRQL) would prospectively predict pediatric healthcare costs over a two-year period. The exploratory hypothesis tested anticipated that a relatively small group of children would account for a disproportionately large percent of healthcare costs.Methods317 children (157 girls) ages 2 to 18 years, members of a managed care health plan with prospective payment participated in a two-year prospective longitudinal study. At Time 1, parents reported child HRQL using the Pediatric Quality of Life Inventory™ (PedsQL™ 4.0) Generic Core Scales, and chronic health condition status. Costs, based on health plan utilization claims and encounters, were derived for 6, 12, and 24 months.ResultsIn multiple linear regression equations, Time 1 parent proxy-reported HRQL prospectively accounted for significant variance in healthcare costs at 6, 12, and 24 months. Adjusted regression models that included both HRQL scores and chronic health condition status accounted for 10.1%, 14.4%, and 21.2% of the variance in healthcare costs at 6, 12, and 24 months. Parent proxy-reported HRQL and chronic health condition status together defined a 'high risk' group, constituting 8.7% of the sample and accounting for 37.4%, 59.2%, and 62% of healthcare costs at 6, 12, and 24 months. The high risk group's per member per month healthcare costs were, on average, 12 times that of other enrollees' at 24 months.ConclusionsWhile these findings should be further tested in a larger sample, our data suggest that parent proxy-reported HRQL can be used to prospectively predict healthcare costs. When combined with chronic health condition status, parent proxy-reported HRQL can identify an at risk group of children as candidates for proactive care coordination.
Highlights
The objective of this study was to test the primary hypothesis that parent proxyreport of pediatric health-related quality of life (HRQL) would prospectively predict pediatric healthcare costs over a two-year period
Adjusted regression models that included both HRQL scores and chronic health condition status accounted for 10.1%, 14.4%, and 21.2% of the variance in healthcare costs at 6, 12, and 24 months
The high risk group's per member per month healthcare costs were, on average, 12 times that of other enrollees' at 24 months. While these findings should be further tested in a larger sample, our data suggest that parent proxy-reported HRQL can be used to prospectively predict healthcare costs
Summary
The objective of this study was to test the primary hypothesis that parent proxyreport of pediatric health-related quality of life (HRQL) would prospectively predict pediatric healthcare costs over a two-year period. Population-based risk prediction and case-mix adjustment can be used to inform policy, set rates, and compare outcomes across providers [2], a more immediate concern for healthcare providers is to clinically manage their enrolled population. Self-reported health status has been shown to be a predictor of future health services charges [3], the use of physician services and mortality in working-age adults [4], and of frailty in the elderly [5]. Several researchers have demonstrated that both diagnostic information and self-rated health status are associated with costs for general adult populations [12,13]. Diagnosis-based classification systems have achieved some degree of association with healthcare costs [14,15]
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