Personal care services provided to children with special health care needs (CSHCN) and their subsequent use of physician services.
BACKGROUND
Medicaid Personal Care Services (PCS) help families meet children's needs for assistance with functional tasks. However, PCS may have other effects on a child's well-being, but research has not yet established the existence of such effects.


OBJECTIVE
To investigate the relationship between the number of PCS hours a child receives with subsequent visits to physicians for evaluation and management (E&M) services.


METHODS
Assessment data for 2058 CSHCN receiving PCS were collected in 2008 and 2009. Assessment data were matched with Medicaid claims data for the period of 1 year after the assessment. Zero-inflated negative binomial and generalized linear multivariate regression models were used in the analyses. These models included patient demographics, health status, household resources, and use of other medical services.


RESULTS
For every 10 additional PCS hours authorized for a child, the odds of having an E&M physician visit in the next year were reduced by 25%. However, the number of PCS hours did not have a significant effect on the number of visits by those children who did have a subsequent E&M visit. A variety of demographic and health status measures also affect physician use.


CONCLUSIONS
Medicaid PCS for CSHCN may be associated with reduced physician usage because of benefits realized by continuity of care, the early identification of potential health threats, or family and patient education. PCS services may contribute to a child's well-being by providing continuous relationships with the care team that promote good chronic disease management, education, and support for the family.
Department of Health Policy and Management, Texas A&M Health Science Center, School of Rural Public Health, 1266 TAMU, College Station, TX 77843, USA.
Thomas R
TR
Miller
Timothy R
TR
Elliott
Darcy M
DM
McMaughan
Ashweeta
A
Patnaik
Emily
E
Naiser
James A
JA
Dyer
Constance J
CJ
Fournier
Catherine
C
Hawes
Charles D
CD
Phillips
D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D019988:Children with Disabilities; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008484:Medicaid; D009819:Office Visits / Q000706:statistics & numerical data*; D010820:Physicians; D014481:United States; D055815:Young Adult
CSHCN; Child and adolescent health; Home care; Medicaid personal care services; Physician services