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Lee CM, Kaplan RM, Nelson SC, Horvitz-Lennon M. Financing the "Village": Establishing a Sustainable Financial System for Child Behavioral Health. Child Adolesc Psychiatr Clin N Am 2024; 33:457-470. [PMID: 38823817 DOI: 10.1016/j.chc.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
An increased need for child and adolescent behavioral health services compounded by a long-standing professional workforce shortage frames our discussion on how behavioral health services can be sustainably delivered and financed. This article provides an overview of different payment models, such as traditional fee-for-service and alternatives like provider salary, global payments, and pay for performance models. It discusses the advantages and drawbacks of each model, emphasizing the need to transition toward value-based care to improve health care quality and control costs.
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Affiliation(s)
- Chuan Mei Lee
- Department of Psychiatry and Behavioral Sciences, UCSF, 675 18th Street, Box 3132, San Francisco, CA 94143, USA; Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA.
| | - Robert M Kaplan
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Suzie C Nelson
- Department of Psychiatry, Wright State University, 2555 University Boulevard, Dayton, OH 45324, USA
| | - Marcela Horvitz-Lennon
- RAND Corporation, 20 Park Plaza, Suite 910, Boston, MA 02116, USA; Department of Psychiatry, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, USA
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Chien AT, Spence SJ, Okumura MJ, Lu S, Chan CH, Houtrow AJ, Kuo DZ, Van Cleave JM, Shanske SA, Schuster MA, Kuhlthau KA, Toomey SL. Impairment Types and Combinations Among Adolescents and Young Adults with Disabilities: Colorado 2014-2018. Acad Pediatr 2024; 24:587-595. [PMID: 37925071 PMCID: PMC11056312 DOI: 10.1016/j.acap.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/25/2023] [Accepted: 10/29/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE Understanding the types of functional challenges faced by adolescents and young adults with disabilities (AYA-WD) can help payers, clinicians, community-based service providers, and policymakers recognize and meet needs. This paper describes state-level prevalence rates for 1) AYA-WD overall and for 2) impairment types singly and in combinations; and 3) examines how rates may differ between those insured by Medicaid versus commercial insurance. METHODS This descriptive study uses Colorado's All Payer Claims Dataset 2014-2018 to identify insured 10- to 26-year-olds (Medicaid only: 333,931; commercially only: 392,444). It then applies the previously validated Children with Disabilities Algorithm (CWDA) and its companion, the Diagnosis-to-Impairment-Type Algorithm (DITA), to compare state-level prevalence rates by insurance source for disability overall and for each of five impairment types singly and in combination. RESULTS Disability prevalence was greater among the Medicaid-insured AYA-WD by +7.6% points (pp)-Medicaid: 11.9% (47,654/333,931), commercial: 4.3% (16,907/392,444). Most AYA-WD had a single impairment, but the prevalence of AYA-WD with two or more impairments was greater among the Medicaid-insured than the commercially insured (+9.9 pp; Medicaid: 33.5% [15,963/47,654], commercial: 23.7% [3992/16, 907]), as was the prevalence of impairment types that were physical (+6.7 pp; Medicaid: 54.7% [26,054/47,654], commercial: 48.0% [8121/16,907]); developmental (+4.1 pp; Medicaid: 35.4% [16,874/47,654], commercial: 31.3% [5290/16,907]); psychiatric (+6.7 pp; Medicaid 21.3% [10,175/47,654], commercial: 14.6% [2470/16,907]), and intellectual (+9.3 pp; Medicaid: 26.2% [12,501/47,654], commercial: 16.9% [2858/16,907]). CONCLUSIONS CWDA and DITA can be used to understand the rates at which impairment types and combinations occur in a population with childhood-onset disabilities.
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Affiliation(s)
- Alyna T Chien
- Division of General Pediatrics (AT Chien and SL Toomey), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (AT Chien and SL Toomey), Harvard Medical School, Boston, Mass.
| | - Sarah J Spence
- Department of Neurology (SJ Spence), Boston Children's Hospital, Boston, Mass
| | - Megumi J Okumura
- Division of General Pediatrics (MJ Okumura), University of California San Francisco Benioff Children's Hospital
| | - Sifan Lu
- College of Medicine, State University of New York-Downstate (S Lu), Brooklyn, NY
| | - Christina H Chan
- Biostatistics and Research Design Center (CH Chan), Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Mass
| | - Amy J Houtrow
- Department of Physical Medicine and Rehabilitation (AJ Houtrow), University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Dennis Z Kuo
- Department of Pediatrics (DZ Kuo), University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Jeanne M Van Cleave
- Department of Pediatrics (JM Van Cleave), Anschutz School of Medicine, University of Colorado, Aurora, CO
| | - Susan A Shanske
- Department of Social Work (SA Shanske), Boston Children's Hospital, Boston, Mass
| | - Mark A Schuster
- Kaiser Permanent Bernard J. Tyson School of Medicine (MA Schuster), Pasadena, Calif
| | - Karen A Kuhlthau
- Center for Child and Adolescent Health Research and Policy (KA Kuhlthau), Department of General Pediatrics, Massachusetts General Hospital for Children, Boston, Mass
| | - Sara L Toomey
- Division of General Pediatrics (AT Chien and SL Toomey), Boston Children's Hospital, Boston, Mass; Department of Pediatrics (AT Chien and SL Toomey), Harvard Medical School, Boston, Mass
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Wisk LE, Garvey KC, Fu C, Landrum MB, Beaulieu ND, Chien AT. Diabetes-Focused Health Care Utilization Among Adolescents and Young Adults With Type 1 Diabetes. Acad Pediatr 2024; 24:59-67. [PMID: 37148967 DOI: 10.1016/j.acap.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 04/27/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To describe the current rates of health services use with various types of providers among adolescents and young adults (AYA) with type 1 diabetes (T1D) and evaluate which patient factors are associated with rates of service use from different provider types. METHODS Using 2012-16 claims data from a national commercial insurer, we identified 18,927 person-years of AYA with T1D aged 13 to 26 years and evaluated the frequency at which: 1) AYA skipped diabetes care for a year despite being insured; 2) received care from pediatric or non-pediatric generalists or endocrinologists if care was sought; and 3) received annual hemoglobin A1c (HbA1c) testing as recommended for AYA. We used descriptive statistics and multivariable regression to examine patient, insurance, and physician characteristics associated with utilization and quality outcomes. RESULTS Between ages 13 and 26, the percentage of AYA with: any diabetes-focused visits declined from 95.3% to 90.3%; the mean annual number of diabetes-focused visits, if any, decreased from 3.5 to 3.0; receipt of ≥2 HbA1c tests annually decreased from 82.3% to 60.6%. Endocrinologists were the majority providers of diabetes care across ages, yet the relative proportion of AYA whose diabetes care was endocrinologist-dominated decreased from 67.3% to 52.7% while diabetes care dominated by primary care providers increased from 19.9% to 38.2%. The strongest predictors of diabetes care utilization were younger age and use of diabetes technology (pumps and continuous glucose monitors). CONCLUSIONS Several provider types are involved in the care of AYA with T1D, though predominate provider type and care quality changes substantially across age in a commercially-insured population.
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Affiliation(s)
- Lauren E Wisk
- Division of General Internal Medicine and Health Services Research (LE Wisk), David Geffen School of Medicine at the University of California, Los Angeles (UCLA); Department of Health Policy and Management (LE Wisk), Fielding School of Public Health at UCLA, Los Angeles, Calif.
| | | | - Christina Fu
- Department of Health Care Policy (C Fu, MB Landrum, and ND Beaulieu), Harvard Medical School, Boston, Mass
| | - Mary Beth Landrum
- Department of Health Care Policy (C Fu, MB Landrum, and ND Beaulieu), Harvard Medical School, Boston, Mass
| | - Nancy D Beaulieu
- Department of Health Care Policy (C Fu, MB Landrum, and ND Beaulieu), Harvard Medical School, Boston, Mass
| | - Alyna T Chien
- Department of Pediatrics (AT Chien), Harvard Medical School, Boston, Mass; Division of General Pediatrics (AT Chien), Boston Children's Hospital, Mass
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Chien AT, Wisk LE, Beaulieu N, Houtrow AJ, Van Cleave J, Fu C, Cutler D, Landrum MB. Specialist use among privately insured children with disabilities. Health Serv Res 2023. [PMID: 37461185 DOI: 10.1111/1475-6773.14199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE To investigate primary care practice ownership and specialist-use patterns for commercially insured children with disabilities. DATA SOURCES AND STUDY SETTING A national commercial claims database and the Health Systems and Provider Database from 2012 to 2016 are the data sources for this study. STUDY DESIGN This cross-sectional, descriptive study examines: (1) the most visited type of pediatric primary care physician and practice (independent or system-owned); (2) pediatric and non-pediatric specialist-use patterns; and (3) how practice ownership relates to specialist-use patterns. DATA COLLECTION/EXTRACTION METHODS This study identifies 133,749 person-years of commercially insured children with disabilities aged 0-18 years with at least 24 months of continuous insurance coverage by linking a national commercial claims data set with the Health Systems and Provider Database and applying the validated Children with Disabilities Algorithm. PRINCIPAL FINDINGS Three-quarters (75.9%) of children with disabilities received their pediatric primary care in independent practices. Nearly two thirds (59.6%) used at least one specialist with 45.1% using nonpediatric specialists, 28.8% using pediatric ones, and 17.0% using both. Specialist-use patterns varied by both child age and specialist type. Children with disabilities in independent practices were as likely to see a specialist as those in system-owned ones: 57.1% (95% confidence interval [95% CI] 56.7%-57.4%) versus 57.3% (95% CI 56.6%-58.0%), respectively (p = 0.635). The percent using two or more types of specialists was 46.1% (95% CI 45.4%-46.7%) in independent practices, comparable to that in systems 47.1% (95% CI 46.2%-48.0%) (p = 0.054). However, the mean number of specialist visits was significantly lower in independent practices than in systems-4.0 (95% CI 3.9%-4.0%) versus 4.4 (95% CI 4.3%-4.6%) respectively-reaching statistical significance with p < 0.0001. CONCLUSIONS Recognizing how privately insured children with disabilities use pediatric primary care from pediatric and nonpediatric primary care specialists through both independent and system-owned practices is important for improving care quality and value.
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Affiliation(s)
- Alyna T Chien
- Division of General Pediatrics, Department of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren E Wisk
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nancy Beaulieu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy J Houtrow
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jeanne Van Cleave
- Department of Pediatrics, University of Colorado School of Medicine, Anshutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Christina Fu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - David Cutler
- Department of Economics, Harvard University, National Bureau of Economic Research, Cambridge, Massachusetts, USA
| | - Mary Beth Landrum
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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Kimmel A, Nozetz E, Salisbury M, Okanlami O, Talwalkar J, Martin A. Treating Children With Physical Disabilities: A Video-Based Educational Resource Using Simulated Participants. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231162579. [PMID: 37077672 PMCID: PMC10107377 DOI: 10.1177/23821205231162579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 02/13/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Children with physical disabilities (CWPD) have historically experienced inadequate and insensitive care across medical settings. A lack of comfort and knowledge about CWPD is prevalent among healthcare provider trainees. We developed a new, readily distributable educational resource about CWPD for healthcare students and conducted a study to determine its efficacy in improving their attitudes toward CWPD. METHODS We collaborated with a working group of stakeholders in the disability community to develop an educational resource for healthcare students. We developed nine short video clips (with a cumulative duration of 27 min) of a primary care visit using simulated participants and embedded them into a 50-min workshop. We conducted a study of the workshop's utility for volunteer healthcare students using synchronous videoconferencing. Participating students completed assessments at baseline and after the workshop. Our primary outcome measure was a change in the Attitudes to Disabled Persons-Original (ATDP-O) scale. RESULTS Forty-nine healthcare students participated in the training session: 29 (59%) from medicine, and 21 (41%) from physician assistant or nursing programs. The materials were easy to deliver virtually. The workshop resulted in measurable change in attitudes regarding physical disabilities, with improvement in ATDP-O scores between baseline (M = 31.2, SD = 8.9) and endpoint (M = 34.8, SD = 10.1) scores (t (49)= 3.28, P = .002, Cohen's d = 0.38). CONCLUSION This video-based educational resource on CWPD is readily distributable and can be delivered virtually as a workshop. The video-enhanced workshop improved healthcare students' perceptions and attitudes toward CWPDs. All materials are available to view, download, or adapt by end-use instructors.
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Affiliation(s)
| | - Erin Nozetz
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Oluwaferanmi Okanlami
- Family Medicine/Physical Medicine &
Rehabilitation/Urology, Michigan Medicine, Ann Arbor, MI, USA
- Services for Students with
Disabilities, and Adaptive Sports & Fitness, University of Michigan, Ann Arbor, MI, USA
| | | | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
- Simulated Participant Program, Teaching
and Learning Center, Yale School of Medicine, New Haven, CT, USA
- Andrés Martin, Child Study Center, Yale
School of Medicine, New Haven, CT 06520, USA.
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Nicholson E, Conlon C, Mimmo L, Doherty E, Guerin S. Unscheduled healthcare for children with intellectual disabilities: A systematic scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:736-751. [PMID: 35322908 PMCID: PMC9314007 DOI: 10.1111/jar.12994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/30/2022]
Abstract
Background The provision of unscheduled healthcare for children with intellectual disability is less researched than that focused on hospital settings or for adult services. The aim of the scoping review was to map the evidence base in this area and identify areas for future study. Method A five‐stage scoping review framework was adopted. CINAHL, PubMed, SCOPUS, PsycINFO, Embase, ProQuest Dissertation & Theses and Google Scholar were searched. Studies published in English after 1/1/2000 were considered eligible for inclusion. Results A total of 3158 titles and abstracts were screened, 137 full‐text articles were reviewed, and 25 papers met the inclusion criteria. Descriptive themes focused on inequities, needs and experiences of families', poor GP training, and limitations of existing evidence. Conclusion Describing trends in healthcare utilisation by this population is valuable for monitoring quality of healthcare, however, addressing observed inequities will require approaches that recognise specific issues within the health system that result in inequities.
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Affiliation(s)
- Emma Nicholson
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland.,School of Psychology, Faculty of Science and Health, Dublin City University, Dublin, Ireland
| | - Ciara Conlon
- Centre for Interdisciplinary Research, Education and Innovation in Health Systems (IRIS), UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Laurel Mimmo
- School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Edel Doherty
- J.E. Cairnes School of Business & Economics, National University of Ireland Galway, Galway, Ireland
| | - Suzanne Guerin
- UCD Centre for Disability Studies, UCD School of Psychology, University College Dublin, Dublin, Ireland
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Adams JS, Chien AT, Wisk LE. Mental Illness Among Youth With Chronic Physical Conditions. Pediatrics 2019; 144:peds.2018-1819. [PMID: 31201229 DOI: 10.1542/peds.2018-1819] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Youth with chronic physical conditions (CPCs) may be at greater risk for developing chronic mental health conditions (MHCs), and limitations in the ability to engage in developmentally appropriate activities may contribute to the risk of MHCs among youth with CPCs. We compared the risk of incident MHCs in youth with and without CPCs and explored whether activity limitations contribute to any such association. METHODS The 2003-2014 Medical Expenditure Panel Survey provided a nationally representative cohort of 48 572 US youth aged 6 to 25 years. We calculated the 2-year cumulative incidence of MHCs overall and by baseline CPC status. Cox proportional hazard models were used to estimate the association between CPCs and incident MHCs, adjusting for sociodemographic characteristics. Stepwise models and the Sobel test evaluated activity limitations as a mediator of this relationship. RESULTS The 2-year cumulative incidence of MHCs was 7.8% overall, 11.5% in youth with CPCs (14.7% of sample), and 7.1% in those without. The adjusted risk of incident MHCs was 51% greater (adjusted hazard ratio 1.51; 95% confidence interval 1.30-1.74) in youth with CPCs compared with those without. Activity limitations mediated 13.5% of this relationship (P < .001). CONCLUSIONS This nationally representative cohort study supports the hypotheses that youth with CPCs have increased risk for MHCs and that activity limitations may play a role in MHC development. Youth with CPCs may benefit from services to bolster their ability to participate in developmentally important activities and to detect and treat new onset MHCs.
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Affiliation(s)
- John S Adams
- Department of Pediatrics, Cambridge Health Alliance, Cambridge, Massachusetts; .,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; and
| | - Alyna T Chien
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; and.,Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Lauren E Wisk
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; and.,Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
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Organizational characteristics associated with high performance on quality measures in pediatric primary care: A positive deviance study. Health Care Manage Rev 2019; 46:196-205. [PMID: 31116122 PMCID: PMC6864254 DOI: 10.1097/hmr.0000000000000247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric health care quality in the United States varies, but the reasons for variation are not fully understood. Differences in pediatric practices' organizational characteristics, such as organizational structures, strategies employed to improve quality, and other contextual factors, may contribute to the variation observed. PURPOSE To assess the relationship between organizational characteristics and performance on clinical quality (CQ) and patient experience (PE) measures in primary care pediatric practices in Massachusetts. METHODOLOGY A 60-item questionnaire that assessed the presence of selected organizational characteristics was sent to 172 pediatric practice managers in Massachusetts between December 2017 and February 2018. The associations between select organizational characteristics and publicly available CQ and PE scores were analyzed using analysis of variance; open-ended survey questions were analyzed using qualitative content analysis. RESULTS Eighty-six practices (50.0%) responded; 80 (46.5%) were included in the primary analysis. Having a quality champion ( p = .03), offering co-located specialty services (e.g., behavioral health; p = .04), being a privately owned practice ( p = .04), believing that patients and families feel respected ( p = .03), and having a lower percentage of patients (10%-25%) covered by public health insurance ( p = .04) were associated with higher CQ scores. Higher PE scores were associated with private practice ownership ( p = .0006). Qualitative analysis suggested organizational culture and external factors, such as health care finance, may affect quality. CONCLUSIONS Both modifiable organizational practices and factors external to a practice may affect quality of care. Addressing differences in practice performance may not be reducible to implementation of changes in single organizational characteristics. PRACTICE IMPLICATIONS Pediatric practices seeking to improve quality of care may wish to adopt the strategies that were associated with higher performance on quality measures, but additional studies are needed to better understand the mechanisms behind these associations and how they relate to each other.
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Shumskiy I, Richardson T, Brar S, Hall M, Cox J, Crofton C, Peltz A, Samuels-Kalow M, Alpern ER, Neuman MI, Berry JG. Well-Child Visits of Medicaid-Insured Children with Medical Complexity. J Pediatr 2018; 199:223-230.e2. [PMID: 29752175 DOI: 10.1016/j.jpeds.2018.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/28/2018] [Accepted: 04/03/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Well-child visits (WCVs) help optimize children's health. We measured annual WCVs for children with medical complexity (CMC) and correlated WCVs with hospitalizations. STUDY DESIGN This was a retrospective analysis of 93 121 CMC aged 1-18 years continuously enrolled in 10 state Medicaid programs in the Truven MarketScan Database between 2010 and 2014. CMC had a complex chronic condition or 3 or more chronic conditions of any complexity identified from International Classification of Diseases, Ninth Revision codes, and the use of 1 or more chronic medications. We measured the number of years with 1 or more WCVs. The χ2 test and logistic regression were used to assess the relationships of WCV-years with the children's characteristics and hospitalization. RESULTS Over 5 years, 13.4% of CMC had 0 WCVs; 17.3% had WCVs in 1 year, 40.8% had WCVs in 2-3 years, and 28.5% had WCVs in 4-5 years. Fewer children received WCVs in 4-5 years when enrolled in Medicaid fee-for-service compared with managed care (20.9% vs 31.5%; P < .001) and when enrolled due to a disability compared with another reason (18.2% vs 32.2%; P < .001). The percentage of CMC hospitalized decreased as the number of years receiving WCV increased (21.5% at 0 years vs 16.9% at 5 years; P < .001). The adjusted odds of hospitalization were higher in CMC with WCVs in 0-4 years compared with CMC with WCVs in all 5 years (OR range across years, 1.1 [95% CI, 1.0-1.2] to 1.3 [95% CI, 1.3-1.4]). CONCLUSIONS Most Medicaid-insured CMC do not receive annual WCVs consistently over time. Children with fewer annual WCVs have a higher likelihood of hospitalization. Further investigation is needed to improve the use of WCVs in CMC.
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Affiliation(s)
- Igor Shumskiy
- Boston Combined Residency Program in Pediatrics, Harvard Medical School, Boston University School of Medicine, Boston, MA
| | | | - Sumeet Brar
- Boston University School of Public Health, Boston, MA
| | - Matt Hall
- Children's Hospital Association, Lenexa, KS
| | - Joanne Cox
- Complex Care Service, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Charis Crofton
- Complex Care Service, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA
| | - Alon Peltz
- Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, CT
| | | | - Elizabeth R Alpern
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mark I Neuman
- Harvard Medical School, Boston, MA; Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA
| | - Jay G Berry
- Complex Care Service, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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