Guideline-informed care among medicaid-enrolled children with food allergy

Madeleine K. Kanaley, Ashley A. Dyer, Olivia R. Negris, Jamie L. Fierstein, Christina E. Ciaccio, Ruchi S. Gupta, Lucy A. Bilaver*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: To describe food allergy (FA)–related service utilization and identify factors associated with guideline-informed care among Medicaid-enrolled US children with FA. STUDY DESIGN: Retrospective cohort study. METHODS: We used the 2012 Medicaid Analytic eXtract files to identify children with an FA diagnosis. FA-related services including outpatient allergist visits, emergency department (ED) visits, epinephrine autoinjector prescription fills, and diagnostic testing were identified. Factors associated with services were assessed using logistic regression. Kaplan-Meier survival curves evaluated the time to guideline-informed care, and proportional hazard models determined associated socioeconomic characteristics. RESULTS: There were 64,276 Medicaid-enrolled children younger than 20 years who had at least 1 claim with an FA diagnosis in 2012. Minority children and those living in a high-poverty county were less likely to have visited an allergist for FA or received diagnostic testing but more likely to have an FA-related ED visit compared with White children and those not living in a high-poverty county. Survival analyses found that of children seen for FA-related primary care or an ED visit, rates of allergist follow-up visits were 21% and 17%, respectively, and rates of epinephrine autoinjector prescription fills were 39% and 41%. Significant associations with guideline-informed care were found by race/ethnicity, dense population, and high-poverty counties. CONCLUSIONS: Although guideline-informed FA care includes follow-up with an allergist and epinephrine autoinjector prescription, this study finds low probabilities of timely service utilization after medical visits, as well as socioeconomic disparities in care.

Original languageEnglish (US)
Pages (from-to)505-512
Number of pages8
JournalAmerican Journal of Managed Care
Issue number12
StatePublished - Dec 2020

ASJC Scopus subject areas

  • Health Policy


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