The utilization of health care resources by children born with a congenital surgical anomaly – the utility of a physician assistant

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Derraugh, Gabrielle
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Introduction: Children born with a congenital surgical anomaly require surgical correction and the care of a multidisciplinary team. Medical and surgical innovation has led to improved survival rates, exposing these children to morbidities, ultimately leading to increased healthcare costs. Physician assistants (PAs) are medical generalists that extend the services of physicians, improve access to care and decrease healthcare costs. Methods: We performed a retrospective cohort study of children born with a congenital surgical anomaly between 1990-2017 using the Winnipeg Surgical Database of Outcomes and Management (WiSDOM) and the Necrotizing Enterocolitis Management and Outcomes (NEMO) database; a 10:1 date-of-birth matched control population was selected using the Manitoba Centre for Health Policy (MCHP). The median cost of consult services, procedures and follow-up services was compared for cases versus controls. A comparative advantage analysis was performed to examine the cost-effectiveness of PAs. Results: Cases generally had a higher median cost for consults, procedures and follow-up services compared to controls. For services provided specifically by general surgeons, cases were found to incur a higher cost primarily for major surgeries. PAs were found to be twice as cost effective as doctors at providing approximately 75% of the care of these patients. Conclusion: Children born with a congenital surgical anomaly had higher healthcare costs than controls. Most of this excess cost is incurred in consult services, major surgeries and follow-up services provided by specialists other than general surgeons. The implementation of PAs into the care of these patients is an effective means of reducing these costs.