Did government subsidy program improve quality of care for children with complex chronic conditions in children's hospitals? A quasi-experimental study in South Korea

초록

Background: Despite advances in medical technology, the number of children with complex chronic conditions (CCC) is increasing. Pediatric critical care involves high cost and low revenue. To address this issue, the Korean government designated and financially supported Specialized Public Medical Centers for Children (SPMCCs). However, rigorous evidence of their effectiveness remains limited.Purpose: We analyzed 30-day readmission rates to determine whether SPMCC designations contributed to improvements in pediatric critical quality of care and assess the presence of a measurable policy effect on readmission reduction.Methods: We included pediatric patients aged 0–18 years with a principal diagnosis of CCC and received care at SPMCCs between 2015 and 2021 using data from the customized National Health Insurance Service database. We applied an interrupted time series analysis with segmented regression to estimate the immediate level and postintervention slope changes in 30-day readmission rates following SPMCC designation. SPMCCs were classified into first and second designation groups based on the timing of their designation.Results: The 30-day readmission rates increased over time in the first and second designation groups. The first group showed a nonsignificant immediate level change at designation (-2.65 percentage points [pp]) but a significant decline in the postintervention slope of observed rates (-1.72 pp per quarter; P<0.001). Likewise, the adjusted 30-day readmission rates showed a nonsignificant level change (-0.75 pp; P=0.69) and a significant slope decline (-1.84 pp/quarter; P<0.001). The second group showed downward trends in 30-day readmission rates after designation in the observed and adjusted analyses; however, these trends were not statistically significant.Conclusion: The SPMCC designation was associated with a meaningful reduction in the trajectory of 30-day readmissions in the first group, providing evidence of a policy-induced reduction in readmissions. These findings highlight the importance of a sustained government investment in maintaining and expanding improvements and strengthening pediatric critical care services.

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