title: Variation in child health care utilization by medical complexity.
abstract: 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. This is a 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. 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 < 0.001). 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 vs. 8.9 out of 10, p < 0.001). Health care models for CMC should account for mental health conditions that may be driving high numbers of outpatient encounters.
authors.affiliation: Department of Pediatrics, Center for Applied Research and Evaluation, University of Arkansas for Medical Sciences, Little Rock, AR, USA, dzkuo@uams.edu.
authors.forename: Dennis Z
authors.initials: DZ
authors.lastname: Kuo
authors.forename: Maria
authors.initials: M
authors.lastname: Melguizo-Castro
authors.forename: Anthony
authors.initials: A
authors.lastname: Goudie
authors.forename: Todd G
authors.initials: TG
authors.lastname: Nick
authors.forename: James M
authors.initials: JM
authors.lastname: Robbins
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Casey
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D002675:Child, Preschool; D002908:Chronic Disease / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D003141:Communicable Diseases / Q000453:epidemiology; D003430:Cross-Sectional Studies; D019988:Children with Disabilities / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010045:Outpatients / Q000706:statistics & numerical data*; D011368:Professional-Family Relations; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology
references.citation: J Pediatr Nurs. 2002 Dec;17(6):424-38
references.pmid: 12518283
references.citation: J Pediatr. 2010 Jun;156(6):1006-1010
references.pmid: 20223482
references.citation: Arch Pediatr Adolesc Med. 2007 Oct;161(10):937-44
references.pmid: 17909136
references.citation: Arch Pediatr Adolesc Med. 2011 Jun;165(6):554-61
references.pmid: 21646589
references.citation: Acad Pediatr. 2010 Nov-Dec;10(6):417-23
references.pmid: 21075324
references.citation: Arch Pediatr Adolesc Med. 2011 May;165(5):392-8
references.pmid: 21300650
references.citation: Pediatrics. 2010 Oct;126(4):638-46
references.pmid: 20855383
references.citation: Acad Pediatr. 2011 Nov-Dec;11(6):508-16
references.pmid: 21962936
references.citation: Pediatrics. 2009 Apr;123(4):1248-51
references.pmid: 19336386
references.citation: Health Serv Res. 2010 Dec;45(6 Pt 2):1948-62
references.pmid: 20819105
references.citation: Pediatrics. 2010 Oct;126(4):647-55
references.pmid: 20855394
references.citation: Pediatrics. 2007 Jun;119(6):1131-8
references.pmid: 17545380
references.citation: Matern Child Health J. 2006 Mar;10(2):201-16
references.pmid: 16382332
references.citation: Ambul Pediatr. 2007 Nov-Dec;7(6):431-8
references.pmid: 17996836
references.citation: Arch Pediatr Adolesc Med. 2011 May;165(5):399-404
references.pmid: 21536953
references.citation: Pediatr Clin North Am. 2005 Aug;52(4):1165-87, x
references.pmid: 16009262
references.citation: Pediatrics. 2000 Jul;106(1 Pt 2):205-9
references.pmid: 10888693
references.citation: Health Serv Res. 2004 Feb;39(1):73-89
references.pmid: 14965078
references.citation: Matern Child Health J. 2009 Mar;13(2):151-63
references.pmid: 18386168
references.citation: Pediatrics. 2012 Dec;130(6):e1463-70
references.pmid: 23184117
references.citation: Med Care Res Rev. 2012 Dec;69(6):619-44
references.pmid: 22645100
references.citation: JAMA Pediatr. 2013 Feb;167(2):170-7
references.pmid: 23266509
references.citation: Matern Child Health J. 2006 Sep;10(5):461-6
references.pmid: 16752093
references.citation: Ambul Pediatr. 2002 Jan-Feb;2(1):38-48
references.pmid: 11888437
references.citation: Arch Pediatr Adolesc Med. 2011 Nov;165(11):1020-6
references.pmid: 22065182
references.citation: Arch Pediatr Adolesc Med. 2011 Jun;165(6):570-2
references.pmid: 21646593
references.citation: JAMA. 2011 Feb 16;305(7):682-90
references.pmid: 21325184
references.citation: Prev Chronic Dis. 2010 Nov;7(6):A132
references.pmid: 20950539
references.citation: Pediatrics. 2011 Mar;127(3):529-38
references.pmid: 21339266
references.citation: J Pediatr. 2011 Aug;159(2):284-90
references.pmid: 21429511