title: Urban/Rural Differences in Therapy Service Use Among Medicaid Children Aged 0-3 With Developmental Conditions in Colorado.
abstract: To describe urban/rural differences in physical (PT) and occupational therapy (OT) service utilization and spending among a sample of young Medicaid-enrolled children with developmental conditions.
  
  
  
  We analyzed Colorado Children's Medicaid administrative claims from 2006 to 2008. The sample included children who were younger than 36 months of age, had a select developmental condition, and were continuously eligible for each study year up to their third birthday. The study outcomes were number of PT/OT claims, type of PT/OT service, and Medicaid PT/OT spending. Multivariable analyses examined urban/rural differences in PT/OT utilization and spending, adjusting for child, family, and health service characteristics.
  
  
  
  The sample included 20,959 children. In adjusted analyses, urban children had 2-fold higher odds (odds ratio 2.18, 95% confidence interval 1.89, 2.51) of receiving PT/OT compared to their rural peers. Median annual per-child Medicaid PT/OT spending was $99 higher ($98.79 [$3.23, $194.35]) for urban children versus rural children. When place of PT/OT service and PT/OT procedures was included, this spending difference was drastically reduced.
  
  
  
  Even accounting for child, family, and health service characteristics, Medicaid PT/OT spending is lower for rural children compared to their urban peers. The difference in spending is largely attributable to utilization of services that are less specialized than urban peers, thus suggesting disparities in access to appropriate PT/OT services.
authors.affiliation: Department of Health Systems, Management and Policy, Colorado School of Public Health, Aurora, Colo. Electronic address: beth.mcmanus@ucdenver.edu.
authors.forename: Beth M
authors.initials: BM
authors.lastname: McManus
authors.affiliation: Department of Health Systems, Management and Policy, Colorado School of Public Health, Aurora, Colo.
authors.forename: Richard
authors.initials: R
authors.lastname: Lindrooth
authors.affiliation: Department of Health Systems, Management and Policy, Colorado School of Public Health, Aurora, Colo.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Richardson
authors.affiliation: Physical Therapy Program, School of Medicine, University of Colorado, Aurora, Colo.
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Rapport
mesh_terms: D002675:Child, Preschool; D003120:Colorado; D002658:Developmental Disabilities / Q000534:rehabilitation*; D005260:Female; D005102:Health Expenditures; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008484:Medicaid; D015999:Multivariate Analysis; D009788:Occupational Therapy / Q000191:economics / Q000706:statistics & numerical data*; D016017:Odds Ratio; D026741:Physical Therapy Modalities / Q000191:economics / Q000706:statistics & numerical data*; D012424:Rural Population; D014481:United States; D014505:Urban Population
keywords: Medicaid; developmental delay; rural; therapy utilization