Long-term Healthcare Utilization by Medicaid Enrolled Children with Neonatal Abstinence Syndrome

Pediatric Primary Care Diagnoses Among Children with Intrauterine Opioid Exposure

BACKGROUND AND OBJECTIVES

Characterizing common concerns for children with intrauterine opioid exposure (IOE) can inform tailored primary care.

METHODS

Retrospective analysis of primary care data of children with IOE from birth to age two years within one multi-state pediatric health system. Well child care (WCC) and problem-based visit diagnoses were categorized, and descriptive statistics were tabulated.

RESULTS

Three hundred and eighty-five (385) children with IOE had 3,622 primary care visits, of which 51.4% were WCC and 48.6% were problem-based. Most frequent visit diagnoses were upper respiratory complaints (14.8% of visits), feeding difficulties (12.2%), and perinatal viral exposure (9.8%). Although visit type (WCC vs. problem-based) varied across diagnostic category, frequent utilization of both visit types were documented for several diagnoses in infancy (e.g., fussiness/colic, feeding difficulties).

CONCLUSIONS

Well child care visits for children with IOE are key opportunities for anticipatory guidance with an emphasis on problems that may contribute to acute health care utilization, particularly in early infancy.

Healthcare utilization among children with a history of neonatal opioid withdrawal syndrome: A matched cohort study

OBJECTIVES

Compare longitudinal healthcare utilization patterns in children with and without a history of neonatal opioid withdrawal syndrome (NOWS).

STUDY DESIGN

A retrospective matched cohort study was conducted using billing data extracted from between 2003 and 2016 in North Texas hospitals. The sample included 595 pediatric patients diagnosed with NOWS (i.e. exposed). The unexposed were patients not diagnosed with NOWS and matched 4:1 on sex, age at first encounter, and ethnicity to the exposed who received care during the same period. Multi-level regression models (accounting for clustered data structure of multiple visits per patient) compared number of hospitalizations, number of outpatient visits, number of emergency department (ED) visits, average length of stay, and healthcare expenditures across patients with and without NOWS.

RESULTS

Hospitalizations were significantly lower among exposed (Incidence Rate Ratio [IRR] = 0.58, 95 % Confidence Interval [CI] = 0.44-0.77) compared to unexposed. Outpatient visits, ED visits, and average length of stay was significantly higher among exposed compared to unexposed (IRR = 1.19, 95 % CI = 1.04-1.36; IRR = 1.22, 95 % CI = 1.04-1.42; IRR = 2.21, 95 % CI = 2.03-2.42, respectively). Overall healthcare expenditure was greater among exposed, as well as for patients with neurologic, endocrine, cardiac, mental disorders, respiratory, perinatal, infectious disease, eye, ear, digestive, congenital anomaly, and skin diagnoses.

CONCLUSIONS

Children with a diagnosis of NOWS have significantly higher healthcare expenditures, and with the exception of hospitalizations, higher healthcare utilization beyond the newborn visit. These findings suggest the needs for interventions for children with NOWS beyond the immediate neonatal period.

Longitudinal Health Care Utilization of Medicaid-Insured Children with a History of Neonatal Abstinence Syndrome

OBJECTIVE

To describe longitudinal health care utilization of Medicaid-insured children with a history of neonatal abstinence syndrome (NAS) compared with similar children without NAS.

STUDY DESIGN

Retrospective, longitudinal cohort study. Data were extracted from the Medicaid Analytic eXtract files for all available states and DC from 2003-2013. Subjects were followed up to 11 years. In total, 17 229 children with NAS were identified using the International Classification of Diseases, Ninth Revision code 779.5. Children without NAS, matched on demographic and health variables, served as the comparison group. Outcomes were number of claims for inpatient, outpatient, and emergency department encounters, numbers of prescription claims, and costs associated with these services. Linked claims were identified for each subject using a unique, within-state ID.

RESULTS

Children with NAS had increased claims for inpatient admissions (marginal effect [ME] 0.49; SE 0.01) and emergency department visits (ME 0.30; SE 0.04) through year 1; increased prescriptions (ME 1.45; SE 0.08, age 0) (ME 0.69; SE 0.11, age 1 year) through year 2; and increased outpatient encounters (ME 20.13; SE 0.54, age 0) (ME 3.95; SE 0.62, age 1 year) (ME 2.90; SE 1.11, age 2 years) through year 3 after adjusting for potential confounders (P < .01 for all). Beyond the third year, health care utilization was similar between those with and without NAS.

CONCLUSIONS

Children with a diagnosis of NAS have greater health care utilization through the third year of life. These differences resolve by the fourth year. Our results suggest resolution of disparities may be due to shifts in developmental health management in school-age children and inability to track relevant diagnoses in a health care database.

Maternal opioid exposure, neonatal abstinence syndrome, and infant healthcare utilization: A retrospective cohort analysis

BACKGROUND

We sought to describe healthcare utilization of infants by maternal opioid exposure and neonatal abstinence syndrome (NAS) status.

METHODS

A longitudinal cohort of 81,833 maternal-infant dyads were identified from Oregon's 2008-2012 linked birth certificate and Medicaid eligibility and claims data. Chi-square tests compared term infants (≥37 weeks of gestational age) by maternal opioid exposure, defined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes or prescription fills, and NAS, defined using ICD-9-CM codes, such that infants were categorized as Opioid+/ NAS+, Opioid+/NAS-, Opioid-/NAS+, and Opioid-/NAS-. Modified Poisson regression was used to calculate adjusted risk ratios (aRR) and 95 % confidence intervals (CI) for healthcare utilization for each infant group compared to Opioid-/NAS- infants.

RESULTS

The prevalence of documented maternal opioid exposure was 123.1 per 1000 dyads and NAS incidence was 5.8 per 1000 dyads. Compared to Opioid-/NAS- infants, infants with maternal opioid exposures were more likely to be hospitalized within 4 weeks (Opioid+/ NAS+: [aRR: 4.7; 95 % CI: 4.3-5.1]; Opioid+/ NAS-: [aRR: 3.7; 95 %CI: 3.1-4.5]) and a year after birth (Opioid+/ NAS+: [aRR: 3.7; 95 %CI: 3.4-4.0]; Opioid+/ NAS-: [aRR: 2.8; 95 %CI: 2.3-3.4]). Infants with maternal opioid exposure and/or NAS were more likely than Opioid-/NAS- infants to have ≥2 sick visits and any ED visits in the year after birth.

CONCLUSIONS

Infants with NAS and/or maternal opioid exposure had greater healthcare utilization than infants without NAS or opioid exposure. Efforts to mitigate future hospitalization risk and encourage participation in preventative services within the first year of life may improve outcomes.