Impact of a Medicaid Primary Care Provider and Preventive Care on Pediatric Hospitalization

Abstract

Most of the children studied were in the AFDC program, about half were African-American, one third resided in Baltimore City, and 9% of children had ICD-9-CMs reflecting chronic disease. The mean percentage of time children were MAC-eligible per quarter was 91%. Only 5% of children were continuously enrolled for all 20 quarters included in this study. Per-capita ambulatory care visits, especially per-capita preventive care visits, increased significantly during the study period (b = 0.003) whereas per-capita ED visits did not change. The mean n

Preventing Hospitalizations in Children With Medical Complexity: A Systematic Review

“…In the Maryland Access to Care (MAC) Medicaid experiment, investigators were only able to classify 38% of ACSC hospitalizations as avoidable. 25 Armour et al 26 found that among 81 patients with spina bifida and a hospitalization for a urinary tract infection (an ACSC), 73 had an ambulatory claim in the 7 days before hospitalization, with 47% of them receiving a diagnosis of urinary tract infections at that time. The study raises the question of how truly "ambulatory care sensitive" urinary tract infections were in this population when .90% of the patients received ambulatory care in the week before hospitalization.…”

“…Five studies 15,25,[37][38][39] assessed various principles from the American Academy of Pediatrics (AAP) medical home model, in particular coordination, accessibility, and family-centeredness. In a broad sample of 43 primary care practices with varying levels of success achieving the medical home principles measured by Medical Home Index (MHI) score, fewer overall hospitalizations were observed in practices with higher MHI scores (specifically higher levels of organizational capacity, data management, chronic condition management, and care coordination).…”

Trends In Avoidable Hospitalizations, 1980–1998

“…2 Preventive care was linked to a reduced probability of avoidable hospitalization for children on Medicaid, and continuity of care with a provider decreased hospitalizations for a Medicaid population of children and adults. 3 Also, persons living in counties designated as primary care shortage areas were found to have more avoidable hospitalizations. 4 In its 1993 report, Access to Health Care in America, the Institute of Medicine (IOM) recommended that avoidable hospitalizations be used to monitor access to health care services at the national level over time, tracking whether conditions for obtaining care were improving or getting worse, especially for vulnerable population groups.…”

An extension in eligibility for free primary care and avoidable hospitalisations: A natural experiment

“…However, a major failing of such regional-level analyses is the potential for ecological fallacy (Epstein, 2001;Parchman et al, 1999). Using individual-level data allows researchers to control more comprehensively for individual characteristics, as well as regional and hospital-level characteristics (Blustein et al, 1998;Culler et al, 1998;Gadomski et al, 1998;Gill et al, 1998;Parker et al, 2000;Weissman et al, 1992).…”

“…The extent to which this system promotes unequal access to GP services has been the subject of an extensive literature (see Section 2), with previous studies all finding that the incentives inherent in medical card eligibility lead to significantly higher levels of GP visiting among those with medical cards, even after controlling for differences in need. Internationally, access to free or heavily subsidised primary care is associated with more frequent GP visits (Chiappori et al, 1998;Jiminez-Martin et al, 2001; van Doorslaer et al, 2002); having a more regular source of care (Centers for Disease Control and Prevention, 1998); increased use of preventative services (DeVoe et al, 2003;Gadomski et al, 1998); and countries with a well-defined primary health care system generally perform better in terms of health outcomes than those who do not (Macinko et al, 2003).…”