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Healthcare Utilization for Medicaid-Insured Children with Medical Complexity: Differences by Sociodemographic Characteristics.

Publication ,  Journal Article
Ming, DY; Jones, KA; White, MJ; Pritchard, JE; Hammill, BG; Bush, C; Jackson, GL; Raman, SR
Published in: Matern Child Health J
December 2022

OBJECTIVE: To compare differences in healthcare utilization and costs for Medicaid-insured children with medical complexity (CMC) by race/ethnicity and rurality. METHODS: Retrospective cohort of North Carolina (NC) Medicaid claims for children 3-20 years old with 3 years continuous Medicaid coverage (10/1/2015-9/30/2018). Exposures were medical complexity, race/ethnicity, and rurality. Three medical complexity levels were: without chronic disease, non-complex chronic disease, and complex chronic disease; the latter were defined as CMC. Race/ethnicity was self-reported in claims; we defined rurality by home residence ZIP codes. Utilization and costs were summarized for 1 year (10/1/2018-9/30/2019) by complexity level classification and categorized as acute care (hospitalization, emergency [ED]), outpatient care (primary, specialty, allied health), and pharmacy. Per-complexity group utilization rates (per 1000 person-years) by race/ethnicity and rurality were compared using adjusted rate ratios (ARR). RESULTS: Among 859,166 Medicaid-insured children, 118,210 (13.8%) were CMC. Among CMC, 36% were categorized as Black non-Hispanic, 42.7% White non-Hispanic, 14.3% Hispanic, and 35% rural. Compared to White non-Hispanic CMC, Black non-Hispanic CMC had higher hospitalization (ARR = 1.12; confidence interval, CI 1.08-1.17) and ED visit (ARR = 1.17; CI 1.16-1.19) rates; Hispanic CMC had lower ED visit (ARR = 0.77; CI 0.75-0.78) and hospitalization rates (ARR = 0.79; CI 0.73-0.84). Black non-Hispanic and Hispanic CMC had lower outpatient visit rates than White non-Hispanic CMC. Rural CMC had higher ED (ARR = 1.13; CI 1.11-1.15) and lower primary care utilization rates (ARR = 0.87; CI 0.86-0.88) than urban CMC. DISCUSSION: Healthcare utilization varied by race/ethnicity and rurality for Medicaid-insured CMC. Further studies should investigate mechanisms for these variations and expand higher value, equitable care delivery for CMC.

Duke Scholars

Published In

Matern Child Health J

DOI

EISSN

1573-6628

Publication Date

December 2022

Volume

26

Issue

12

Start / End Page

2407 / 2418

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Retrospective Studies
  • Public Health
  • Patient Acceptance of Health Care
  • Medicaid
  • Humans
  • Chronic Disease
  • Child, Preschool
  • Child
 

Citation

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Ming, D. Y., Jones, K. A., White, M. J., Pritchard, J. E., Hammill, B. G., Bush, C., … Raman, S. R. (2022). Healthcare Utilization for Medicaid-Insured Children with Medical Complexity: Differences by Sociodemographic Characteristics. Matern Child Health J, 26(12), 2407–2418. https://doi.org/10.1007/s10995-022-03543-x
Ming, David Y., Kelley A. Jones, Michelle J. White, Jessica E. Pritchard, Bradley G. Hammill, Christopher Bush, George L. Jackson, and Sudha R. Raman. “Healthcare Utilization for Medicaid-Insured Children with Medical Complexity: Differences by Sociodemographic Characteristics.Matern Child Health J 26, no. 12 (December 2022): 2407–18. https://doi.org/10.1007/s10995-022-03543-x.
Ming DY, Jones KA, White MJ, Pritchard JE, Hammill BG, Bush C, et al. Healthcare Utilization for Medicaid-Insured Children with Medical Complexity: Differences by Sociodemographic Characteristics. Matern Child Health J. 2022 Dec;26(12):2407–18.
Ming, David Y., et al. “Healthcare Utilization for Medicaid-Insured Children with Medical Complexity: Differences by Sociodemographic Characteristics.Matern Child Health J, vol. 26, no. 12, Dec. 2022, pp. 2407–18. Pubmed, doi:10.1007/s10995-022-03543-x.
Ming DY, Jones KA, White MJ, Pritchard JE, Hammill BG, Bush C, Jackson GL, Raman SR. Healthcare Utilization for Medicaid-Insured Children with Medical Complexity: Differences by Sociodemographic Characteristics. Matern Child Health J. 2022 Dec;26(12):2407–2418.
Journal cover image

Published In

Matern Child Health J

DOI

EISSN

1573-6628

Publication Date

December 2022

Volume

26

Issue

12

Start / End Page

2407 / 2418

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Retrospective Studies
  • Public Health
  • Patient Acceptance of Health Care
  • Medicaid
  • Humans
  • Chronic Disease
  • Child, Preschool
  • Child