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Variation in Child Health Care Utilization by Medical Complexity

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Abstract

Children with medical complexity (CMC) have multiple specialty need, technology dependence, and high health care utilization. The objective of this study is to profile types of pediatric health care utilization and costs by increasing levels of medical complexity. This is a cross-sectional study of the 2007, 2008 and 2009 Full-Year Data Sets from the Medical Expenditure Panel Survey. Medical complexity was defined by a higher number of positive items from the five question children with special health care needs (CSHCN) Screener. CMC were defined by ≥4 positive screener items. Outcomes included the number of inpatient, outpatient, and emergency department visits, associated costs and diagnoses, and reported satisfaction. ICD-9 codes were grouped by Clinical Classifications Software. Of 27,755 total study subjects ≤17 years, 4,851 had special needs and 541 were CMC. Older age, male gender, white/non-Hispanic race/ethnicity, and public insurance were all associated with medical complexity (all p < 0.001). CMC had an annual mean of 19 annual outpatient visits ($616) and 0.26 inpatient visits ($3,308), with other significant cost drivers including home health ($2,957) and prescriptions ($2,182). The most common reasons for non-CSHCN and less-complex CSHCN outpatient visits were viral illnesses, while the main reasons for CMC visits were for mental health. Compared to families without CSHCN, those with CMC have, on average, lower satisfaction with health care (8.4 vs. 8.9 out of 10, p < 0.001). Health care models for CMC should account for mental health conditions that may be driving high numbers of outpatient encounters.

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Abbreviations

CSHCN:

Children with special health care needs

MEPS:

Medical Expenditure Panel Survey

CCS:

Clinical Classification Software

ED:

Emergency department

References

  1. Neff, J. M., Sharp, V. L., Muldoon, J., Graham, J., & Myers, K. (2004). Profile of medical charges for children by health status group and severity level in a Washington State Health Plan. Health Services Research, 39(1), 73–89.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Cohen E, Berry JG, Camacho X, Anderson G, Wodchis W, Guttmann A. (2012) Patterns and costs of health care use of children with medical complexity. Pediatrics, 130(6), e1463–e1470.

    Google Scholar 

  3. Cohen, E., Kuo, D. Z., Agrawal, R., et al. (2011). Children with medical complexity: An emerging population for clinical and research initiatives. Pediatrics, 127(3), 529–538.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Kuo, D. Z., Cohen, E., Agrawal, R., Berry, J. G., & Casey, P. H. (2011). A national profile of caregiver challenges among more medically complex children with special health care needs. Archives of Pediatrics and Adolescent Medicine, 165(6), 1020–1026.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Berry, J. G., Hall, D. E., Kuo, D. Z., et al. (2011). Hospital utilization and characteristics of patients experiencing recurrent readmissions within children’s hospitals. JAMA, 305(7), 682–690.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Berry, J. G., Agrawal, R. K., Cohen, E., & Kuo, D. Z. (2013). The landscape of medical care for children with medical complexity. Overland Park: Children’s Hospital Association.

    Google Scholar 

  7. Agrawal, R., & Antonelli, R. C. (2011). Hospital-based programs for children with special health care needs: implications for health care reform. Archives of Pediatrics and Adolescent Medicine, 165(6), 570–572.

    Article  PubMed  Google Scholar 

  8. Burns, K. H., Casey, P. H., Lyle, R. E., Bird, T. M., Fussell, J. J., & Robbins, J. M. (2010). Increasing prevalence of medically complex children in US hospitals. Pediatrics, 126(4), 638–646.

    Article  PubMed  Google Scholar 

  9. Simon, T. D., Berry, J., Feudtner, C., et al. (2010). Children with complex chronic conditions in inpatient hospital settings in the United States. Pediatrics, 126(4), 647–655.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Berry, J. G., Hall, M., Hall, D. E., et al. (2013). Inpatient growth and resource use in 28 children’s hospitals: A longitudinal, multi-institutional study. JAMA Pediatrics, 167(2), 170–177.

    Google Scholar 

  11. Casey, P. H., Lyle, R. E., Bird, T. M., et al. (2011). Effect of hospital-based comprehensive care clinic on health costs for medicaid-insured medically complex children. Archives of Pediatrics and Adolescent Medicine, 165(5), 392–398.

    Article  PubMed  Google Scholar 

  12. Gordon, J. B., Colby, H. H., Bartelt, T., Jablonski, D., Krauthoefer, M. L., & Havens, P. (2007). A tertiary care-primary care partnership model for medically complex and fragile children and youth with special health care needs. Archives of Pediatrics and Adolescent Medicine, 161(10), 937–944.

    Article  PubMed  Google Scholar 

  13. Klitzner, T. S., Rabbitt, L. A., & Chang, R. K. (2010). Benefits of care coordination for children with complex disease: a pilot medical home project in a resident teaching clinic. Journal of Pediatrics, 156(6), 1006–1010.

    Article  PubMed  Google Scholar 

  14. Buescher, P. A., Whitmire, J. T., Brunssen, S., & Kluttz-Hile, C. E. (2006). Children who are medically fragile in North Carolina: using Medicaid data to estimate prevalence and medical care costs in 2004. Maternal and Child Health Journal, 10(5), 461–466.

    Article  PubMed  Google Scholar 

  15. Raphael, J. L., Mei, M., Brousseau, D. C., & Giordano, T. P. (2011). Associations between quality of primary care and health care use among children with special health care needs. Archives of Pediatrics and Adolescent Medicine, 165(5), 399–404.

    Article  PubMed  Google Scholar 

  16. Brousseau, D. C., Hoffmann, R. G., Nattinger, A. B., Flores, G., Zhang, Y., & Gorelick, M. (2007). Quality of primary care and subsequent pediatric emergency department utilization. Pediatrics, 119(6), 1131–1138.

    Article  PubMed  Google Scholar 

  17. Bethell, C. D., Read, D., Stein, R. E., Blumberg, S. J., Wells, N., & Newacheck, P. W. (2002). Identifying children with special health care needs: development and evaluation of a short screening instrument. Ambulatory Pediatrics, 2(1), 38–48.

    Article  PubMed  Google Scholar 

  18. Yu, H., & Dick, A. W. (2010). Risk-adjusted capitation rates for children: how useful are the survey-based measures? Health Services Research, 45(6 Pt 2), 1948–1962.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Bramlett, M. D., Read, D., Bethell, C., & Blumberg, S. J. (2009). Differentiating subgroups of children with special health care needs by health status and complexity of health care needs. Maternal and Child Health Journal, 13(2), 151–163.

    Article  PubMed  Google Scholar 

  20. Houtrow, A. J., Okumura, M. J., Hilton, J. F., & Rehm, R. S. (2011). Profiling health and health-related services for children with special health care needs with and without disabilities. Academic Pediatrics, 11(6), 508–516.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Berry, J. G., Agrawal, R., Kuo, D. Z., et al. (2011). Characteristics of hospitalizations for patients who utilize a structured clinical-care program for children with medical complexity. Journal of Pediatrics, 159(2), 284–290.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Srivastava, R., Stone, B. L., & Murphy, N. A. (2005). Hospitalist care of the medically complex child. Pediatric Clinics of North America, 52(4), 1165–1187.

    Article  PubMed  Google Scholar 

  23. Cohen, E., Kuo, D. Z., Agrawal, R., et al. (2011). Children with medical complexity: An emerging population for clinical and research initiatives. Pediatrics, 127(3), 529–538.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Cohen, E., Jovcevska, V., Kuo, D. Z., & Mahant, S. (2011). Hospital-based comprehensive care programs for Children with Special Health Care Needs (CSHCN): A systematic review. Archives of Pediatrics and Adolescent Medicine, 165(6), 554–561.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Antonelli, R. C., McAllister, J. W., & Popp, J. (2009). Making care coordination a critical component of the pediatric health system: A multidisciplinary framework. New York: The Commonwealth Fund.

    Google Scholar 

  26. Inkelas, M., Raghavan, R., Larson, K., Kuo, A. A., & Ortega, A. N. (2007). Unmet mental health need and access to services for children with special health care needs and their families. Ambulatory Pediatrics, 7(6), 431–438.

    Article  PubMed  Google Scholar 

  27. Warfield, M. E., & Gulley, S. (2006). Unmet need and problems accessing specialty medical and related services among children with special health care needs. Maternal and Child Health Journal, 10(2), 201–216.

    Article  PubMed  Google Scholar 

  28. Ray, L. D. (2002). Parenting and childhood chronicity: Making visible the invisible work. Journal of Pediatric Nursing, 17(6), 424–438.

    Article  PubMed  Google Scholar 

  29. Hoff, T., Weller, W., & Depuccio, M. (2012). The patient-centered medical home: A review of recent research. Medical Care Research and Review, 69(6), 619–644.

    Article  PubMed  Google Scholar 

  30. Hogan, M. F., Sederer, L. I., Smith, T. E., & Nossel, I. R. (2010). Making room for mental health in the medical home. Preventing Chronic Disease, 7(6), A132.

    PubMed Central  PubMed  Google Scholar 

  31. American Academy of Child and Adolescent Psychiatry Committee on Health Care Access and Economics Task Force on Mental Health. (2009). Improving mental health services in primary care: reducing administrative and financial barriers to access and collaboration. Pediatrics, 123(4), 1248–1251.

    Article  Google Scholar 

  32. Feudtner, C., Christakis, D. A., & Connell, F. A. (2000). Pediatric deaths attributable to complex chronic conditions: A population-based study of Washington State, 1980–1997. Pediatrics, 106(1 Pt 2), 205–209.

    CAS  PubMed  Google Scholar 

  33. Neff, J. M., Clifton, H., Park, K. J., et al. (2010). Identifying children with lifelong chronic conditions for care coordination by using hospital discharge data. Academic Pediatrics, 10(6), 417–423.

    Article  PubMed  Google Scholar 

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Acknowledgments

Two of the authors were supported by grants 8 KL2 TR000063-04 and 8 UL1 TR000039-04 through the National Center for Advancing Translational Sciences. The authors have no financial relationships relevant to this article to disclose.

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Authors and Affiliations

  1. Department of Pediatrics, Center for Applied Research and Evaluation, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Dennis Z. Kuo, Anthony Goudie, James M. Robbins & Patrick H. Casey

  2. Section on Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Maria Melguizo-Castro & Todd G. Nick

  3. Arkansas Children’s Hospital, Pediatrics/CARE Slot 512-26, 1 Children’s Way, Little Rock, AR, 72202, USA

    Dennis Z. Kuo

Authors
  1. Dennis Z. Kuo
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  2. Maria Melguizo-Castro
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  6. Patrick H. Casey
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Correspondence to Dennis Z. Kuo.

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Kuo, D.Z., Melguizo-Castro, M., Goudie, A. et al. Variation in Child Health Care Utilization by Medical Complexity. Matern Child Health J 19, 40–48 (2015). https://doi.org/10.1007/s10995-014-1493-0

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  • DOI: https://doi.org/10.1007/s10995-014-1493-0

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