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Prediction of Resource Use During Acute Pediatric Illnesses
Paul McCarthy, MD;
Theodore Walls, PhD;
Dominic Cicchetti, PhD;
Linda Mayes, MD;
John Rizzo, PhD;
Jorge Lopez-Benitez, MD;
Sadek Salloum, MD;
Michael Baron, MD;
Howard Fink, MD;
Robert Anderson, MD;
Todd Little, PhD;
Robert LaCamera, MD;
Kimberly Freudigman, PhD
Arch Pediatr Adolesc Med. 2003;157:990-996.
Background Significant resources are used for acute illnesses in children. Identifying predictors of resource use can focus interventions to reduce this use.
Objective To determine the relative effects of maternal, infant, social milieu, and demographic characteristics, the mother-child interaction, and perception of illness severity on the use of resources during acute illnesses in children.
Design At the 2-week and 6-, 15-, and 24-month well-child care visits of a cohort of mother-infant dyads, the mother–well-child interaction was assessed by using the Biringen Emotional Availability Scales, and data were gathered regarding maternal depression and sense of competence, infant temperament, maternal social support, the home environment, and demographic characteristics. At each of the cohort's 1983 ill-child care visits during 30 months of follow-up, the mother–ill-child interaction was assessed by using the Emotional Availability Scales, and mothers and pediatricians independently assessed illness severity using the Acute Illness Observation Scales. Resources used during the illnesses—over-the-counter and prescription medications, tests, hospitalizations, follow-up visits, and the emergency department—were assessed.
Setting A hospital primary care center and an urban and a suburban private practice.
Patients Between February 1, 1995, and March 30, 1998, a consecutive sample of 380 dyads were asked to enroll at the 2-week well-child care visit; 316 (83.2%) consented, and complete data were available for analysis of 243 dyads.
Main Outcome Measures A path analytic framework using a structural equation model assessed the presence and strength of predictive relationships between demographic, maternal, infant, and social milieu data, the Biringen Emotional Availability Scales, and the Acute Illness Observation Scales and the main outcome measure, resource use.
Results Three variables predicted greater mean resource use during each acute illness episode: a less optimal mother-child interaction ( = -.53), lower scores for parenting sense of competence ( = -.26), and greater perception of illness severity by mothers ( = .33). By using the coefficient of determination (R2), these 3 predictors account for 55% of the reliable variance in resource use during acute illnesses.
Conclusion The quality of the mother-child interaction, maternal sense of competence, and maternal assessment of severity of the illness are major predictors of resource use during acute pediatric illnesses, and should be important foci of interventions to reduce resource use.
From the Departments of Pediatrics (Drs McCarthy, Walls, Lopez-Benitez, Salloum, Baron, Fink, Anderson, LaCamera, and Freudigman) and Epidemiology and Public Health (Dr Rizzo) and the Yale Child Study Center (Drs Cicchetti and Mayes), Yale University School of Medicine and Yale–New Haven Children's Hospital, and the Department of Psychology, Yale University (Dr Little), New Haven, Conn; and the College of Medicine and Public Health, The Ohio State University, Columbus (Dr Rizzo).
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