title: Self-Management and Health Care Use in an Adolescent and Young Adult Medicaid Population With Differing Chronic Illnesses.
abstract: BACKGROUND
  Few studies of adults question the validity of the claim that self-management reduces the use of health care services and, as a result, health care costs. The aim of our study was to determine the relationship between self-management and health care use in a population of adolescent and young adult recipients of North Carolina Medicaid with chronic health conditions, who received care in either the pediatric or adult clinic. Our secondary objective was to characterize the patterns of health care use among this same population.
  
  
  METHODS
  One hundred and fifty adolescents or young adults aged 14 to 29 were recruited for this study. Participants completed a demographics questionnaire and the self-management subdomain of the University of North Carolina TRxANSITION Scale. Information on each participant's emergency department and inpatient use was obtained by using the North Carolina Medicaid Provider Portal.
  
  
  RESULTS
  This cohort had a high level of emergency health care use; average lifetime use was 3.18 (standard deviation [SD], 5.58) emergency department visits, 2.02 (SD, 3.42) inpatient visits, and 12.5 (SD, 23.9 ) days as an inpatient. Age group (pediatric or adult), diagnosis, race/ethnicity, and sex were controlled for in all analyses. Results indicate that patients with a high rate of disease self-management had more emergency department visits and hospitalizations and a longer length of stay in the hospital than did those with a low rate.
  
  
  CONCLUSIONS
  In a group of North Carolina Medicaid recipients with chronic conditions, better self-management is associated with more health care use. This is likely the result of many factors, including more interactions with health care professionals, greater ability to recognize the need for emergency medical attention, and the use of the emergency department for primary health care.
authors.affiliation: The University of North Carolina, Chapel Hill, Chapel Hill, North Carolina.
authors.forename: G Alexandra
authors.initials: GA
authors.lastname: Phillips
authors.affiliation: Dana-Farber/Boston's Children Cancer and Blood Disorders Center, Boston, Massachusetts.
authors.forename: Nicole
authors.initials: N
authors.lastname: Fenton
authors.affiliation: The University of North Carolina, Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cohen
authors.affiliation: The University of North Carolina, Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Karina
authors.initials: K
authors.lastname: Javalkar
authors.affiliation: University of North Carolina Kidney Center, 7021 Burnett Womack, CB No. 7155, Chapel Hill, NC 27514. Email: maria_ferris@med.unc.edu.
authors.forename: Maria
authors.initials: M
authors.lastname: Ferris
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid; D009657:North Carolina / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000523:psychology; D012648:Self Care / Q000523:psychology / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States; D014600:Utilization Review; D055815:Young Adult