Variation in Child Health Care Utilization by Medical Complexity

Abstract

Objectives 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. Methods 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. Results 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<.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 versus 8.9 out of 10, p<.001). Conclusion Health care models for CMC should account for mental health conditions that may be driving high numbers of outpatient encounters.

Hospital Utilization Among Children With the Highest Annual Inpatient Cost

“…[1][2][3][4][5][6] In recent years, there has been a significant rise in innovative clinical programs targeting this population of children. 7 Health plans, children's hospitals, and other entities are enrolling high-cost children into care management programs to improve their health.…”

The Impact of Telehealth and Care Coordination on the Number and Type of Clinical Visits for Children With Medical Complexity

“…85% of children in the TeleFamilies Project had multiple complex chronic conditions, and approximately half required life-sustaining technology assistance. Previous studies of health care service use in this population have shown a correlation between increasing positive responses on the CSHCN screener and the number of hospital visits (Cohen et al, 2012; Kuo et al, 2014). …”

Key constituents for integration of care for children assisted with long-term home ventilation: a European study

“…There is evidence in wider literature on the care of children with CCNs that there are numerous and varied characteristics of a family that need to be understood to support family preparedness for discharge to home that goes well beyond clinical readiness to care. This includes issues relating to language, culture, race and ethnicity [24][25][26], family structures and support systems [27][28][29] and capacity for coping [30][31][32]. The fact that the majority of countries do not currently collect data on the experience of care from the perspective of the parents/guardians or siblings of children assisted with LTV, suggests a persistent paternalistic health service with a limited appetite for identifying and addressing the real needs of the child and family.…”