{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T13:11:54Z","timestamp":1783689114548,"version":"3.55.0"},"reference-count":42,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2020,7,3]],"date-time":"2020-07-03T00:00:00Z","timestamp":1593734400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000221","name":"Canadian Lung Association","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000221","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Children using home mechanical ventilation (HMV) live at home with better quality of life, despite financial burden for their family. Previous studies of healthcare utilization and costs have not considered public and private expenditures, including family caregiver time. Our objective was to examine public and private healthcare utilization and costs for children using HMV, and variables associated with highest costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Longitudinal, prospective, observational cost analysis study (2012\u20102014) collecting data on public and private (out\u2010of\u2010pocket, third\u2010party insurance, and caregiving) costs every 2 weeks for 6 months using the Ambulatory Home Care Record. Functional Independence Measure (FIM), WeeFIM, and Caregiving Impact Scale (CIS) were measured at baseline and study completion. Regression modeling examined a priori selected variables associated with monthly costs using Andersen and Newman's framework for healthcare utilization, relevant literature, and clinical expertise. Data are reported in 2015 Canadian dollars ($1CAD\u2009=\u2009$0.78USD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty two children and their caregivers were enrolled. Overall median (interquartile range) monthly healthcare cost was $12\u2009131 ($8159\u2010$15\u2009958) comprising $9929 (89%) family caregiving hours, $996 (9%) publicly funded, and $252 (2%) out\u2010of\u2010pocket (&lt;1% third\u2010party insurance) costs. With higher FIM score (lower dependency), median costs were reduced by 4.5% (95% confidence interval: 8.3%\u20100.5%), adjusted for age, sex, tracheostomy, and daily ventilation duration. Note: since the three cost categories did not sum to the total statistically derived median cost, the <jats:italic>percentage<\/jats:italic> of each category used the sum of median public + caregiver lost time + private out\u2010of\u2010pocket + third\u2010party insurance as the denominator.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>For HMV children, most healthcare costs were due to family caregiving costs. More dependent children incur highest costs. The financial burden to family caregivers is substantial and needs to considered in future policy decisions related to pediatric HMV.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ppul.24923","type":"journal-article","created":{"date-parts":[[2020,6,24]],"date-time":"2020-06-24T16:38:06Z","timestamp":1593016686000},"page":"2368-2376","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Healthcare utilization and costs of pediatric home mechanical ventilation in Canada"],"prefix":"10.1002","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5323-9638","authenticated-orcid":false,"given":"Mika L.","family":"Nonoyama","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences Ontario Tech University  Oshawa Canada"},{"name":"Department of Respiratory Therapy The Hospital for Sick Children  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1879-1990","authenticated-orcid":false,"given":"Sherri L.","family":"Katz","sequence":"additional","affiliation":[{"name":"Division of Respirology, CHEO University of Ottawa  Ottawa Canada"},{"name":"Clinical Research Unit CHEO Research Institute  Ottawa Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3032-5434","authenticated-orcid":false,"given":"Reshma","family":"Amin","sequence":"additional","affiliation":[{"name":"Division of Respiratory Medicine, The Hospital for Sick Children University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas A.","family":"McKim","sequence":"additional","affiliation":[{"name":"Division of Respiratory Medicine The Ottawa Hospital  Ottawa Canada"},{"name":"Ottawa Hospital Research Institute  Ottawa Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Guerriere","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation University of Toronto  Toronto Canada"},{"name":"Canadian Centre for Health Economics  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2993-3491","authenticated-orcid":false,"given":"Peter C.","family":"Coyte","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Wasilewski","sequence":"additional","affiliation":[{"name":"St. John's Rehab Research Program Sunnybrook Research Institute  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1535-1685","authenticated-orcid":false,"given":"Brandon","family":"Zagorski","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1700-3972","authenticated-orcid":false,"given":"Louise","family":"Rose","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Toronto  Toronto Canada"},{"name":"Department of Critical Care Medicine Sunnybrook Health Sciences Centre  Toronto Canada"},{"name":"Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care King's College London  London England"},{"name":"Lawrence S. 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