TY - JOUR
T1 - Well-Child Visits of Medicaid-Insured Children with Medical Complexity
AU - Shumskiy, Igor
AU - Richardson, Troy
AU - Brar, Sumeet
AU - Hall, Matt
AU - Cox, Joanne
AU - Crofton, Charis
AU - Peltz, Alon
AU - Samuels-Kalow, Margaret
AU - Alpern, Elizabeth R.
AU - Neuman, Mark I.
AU - Berry, Jay G.
N1 - Funding Information:
J.B., M.H., and T.R. were supported by the Maternal and Child Health Bureau (Grant R40MC29443 ). The authors declare no conflicts of interest.
Publisher Copyright:
© 2018
PY - 2018/8
Y1 - 2018/8
N2 - 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 χ 2 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.
AB - 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 χ 2 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.
KW - children with medical complexity
KW - hospitalization
KW - primary care
KW - well child visits
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U2 - 10.1016/j.jpeds.2018.04.003
DO - 10.1016/j.jpeds.2018.04.003
M3 - Article
C2 - 29752175
AN - SCOPUS:85046632390
VL - 199
SP - 223-230.e2
JO - Journal of Pediatrics
JF - Journal of Pediatrics
SN - 0022-3476
ER -