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J Pediatr. 2018 Aug;199:223-230.e2. doi: 10.1016/j.jpeds.2018.04.003. Epub 2018 May 8.

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

Author information

1
Boston Combined Residency Program in Pediatrics, Harvard Medical School, Boston University School of Medicine, Boston, MA.
2
Children's Hospital Association, Lenexa, KS.
3
Boston University School of Public Health, Boston, MA.
4
Complex Care Service, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
5
Complex Care Service, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA.
6
Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, CT.
7
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
8
Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
9
Harvard Medical School, Boston, MA; Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA.
10
Complex Care Service, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: jay.berry@childrens.harvard.edu.

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 χ2 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.

KEYWORDS:

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

PMID:
29752175
DOI:
10.1016/j.jpeds.2018.04.003
[Indexed for MEDLINE]

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