Well-Child Visits of Medicaid-Insured Children with Medical Complexity

Igor Shumskiy, Troy Richardson, Sumeet Brar, Matt Hall, Joanne Cox, Charis Crofton, Alon Peltz, Margaret Samuels-Kalow, Elizabeth R Alpern, Mark I. Neuman, Jay G. Berry*

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Scopus citations

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 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.

Original languageEnglish (US)
Pages (from-to)223-230.e2
JournalJournal of Pediatrics
Volume199
DOIs
StatePublished - Aug 1 2018

Keywords

  • children with medical complexity
  • hospitalization
  • primary care
  • well child visits

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Shumskiy, I., Richardson, T., Brar, S., Hall, M., Cox, J., Crofton, C., Peltz, A., Samuels-Kalow, M., Alpern, E. R., Neuman, M. I., & Berry, J. G. (2018). Well-Child Visits of Medicaid-Insured Children with Medical Complexity. Journal of Pediatrics, 199, 223-230.e2. https://doi.org/10.1016/j.jpeds.2018.04.003