title: Shared decision-making and health care expenditures among children with special health care needs.
abstract: OBJECTIVE
  To understand the association between shared decision-making (SDM) and health care expenditures and use among children with special health care needs (CSHCN).
  
  
  METHODS
  We identified CSHCN <18 years in the 2002-2006 Medical Expenditure Panel Survey by using the CSHCN Screener. Outcomes included health care expenditures (total, out-of-pocket, office-based, inpatient, emergency department [ED], and prescription) and utilization (hospitalization, ED and office visit, and prescription rates). The main exposure was the pattern of SDM over the 2 study years (increasing, decreasing, or unchanged high or low). We assessed the impact of these patterns on the change in expenditures and utilization over the 2 study years.
  
  
  RESULTS
  Among 2858 subjects representing 12 million CSHCN, 15.9% had increasing, 15.2% decreasing, 51.9% unchanged high, and 17.0% unchanged low SDM. At baseline, mean per child total expenditures were $2131. Over the 2 study years, increasing SDM was associated with a decrease of $339 (95% confidence interval: $21, $660) in total health care costs. Rates of hospitalization and ED visits declined by 4.0 (0.1, 7.9) and 11.3 (4.3, 18.3) per 100 CSHCN, and office visits by 1.2 (0.3, 2.0) per child with increasing SDM. Relative to decreasing SDM, increasing SDM was associated with significantly lower total and out-of-pocket costs, and fewer office visits.
  
  
  CONCLUSIONS
  We found that increasing SDM was associated with decreased utilization and expenditures for CSHCN. Prospective study is warranted to confirm if fostering SDM reduces the costs of caring for CSHCN for the health system and families.
authors.affiliation: The Pediatric Generalist Research Group (PeRC), The Children's Hospital of Philadelphia, 3535 Market Suite, Room 1546, Philadelphia, PA 19104, USA. fiks@email.chop.edu
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Fiks
authors.forename: Stephanie
authors.initials: S
authors.lastname: Mayne
authors.forename: A Russell
authors.initials: AR
authors.lastname: Localio
authors.forename: Evaline A
authors.initials: EA
authors.lastname: Alessandrini
authors.forename: James P
authors.initials: JP
authors.lastname: Guevara
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003657:Decision Making; D019988:Children with Disabilities; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006301:Health Services Needs and Demand; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D011368:Professional-Family Relations; D012959:Socioeconomic Factors; D014481:United States