title: Healthcare Utilization and Spending for Constipation in Children With Versus Without Complex Chronic Conditions.
abstract: The aim of the study was to examine the prevalence of diagnosis and treatment for constipation among children receiving Medicaid and to compare healthcare utilization and spending for constipation among children based on number of complex chronic conditions (CCCs).
  
  
  
  Retrospective cohort study of 4.9 million children ages 1 to 17 years enrolled in Medicaid from 2009 to 2011 in 10 states in the Truven Marketscan Database. Constipation was identified using International Classification of Disease, 9th revision codes for constipation (564.0x), intestinal impaction (560.3x), or encopresis (307.7). Outpatient and inpatient utilization and spending for constipation were assessed. CCC status was identified using validated methodology.
  
  
  
  A total of 267,188 children (5.4%) were diagnosed with constipation. Total constipation spending was $79.5 million. Outpatient constipation spending was $66.8 million (84.1%) during 406,814 visits, mean spending $120/visit. Among children with constipation, 1363 (0.5%) received inpatient treatment, accounting for $12.2 million (15.4%) of constipation spending, mean spending $7815/hospitalization. Of children hospitalized for constipation, 552 (40.5%) did not have an outpatient visit for constipation before admission. Approximately 6.8% of children in the study had ≥1 CCC; these children accounted for 33.5% of total constipation spending, 70.3% of inpatient constipation spending, and 19.8% of emergency department constipation spending. Constipation prevalence was 11.0% for children with 1 CCC, 16.6% with 2 CCCs, and 27.1% with ≥3 CCCs.
  
  
  
  Although the majority of pediatric constipation treatment occurs in the outpatient setting, inpatient care accounts for a sizable percentage of spending. Children with CCCs have a higher prevalence of constipation and account for a disproportionate amount of constipation healthcare utilization and spending.
authors.affiliation: *Division of General Pediatrics and Adolescent Medicine, University of North Carolina, School of Medicine, Chapel Hill, NC †Children's Hospital Association, Overland Park, KS ‡Department of Medicine, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: John R
authors.initials: JR
authors.lastname: Stephens
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Steiner
authors.forename: Neal
authors.initials: N
authors.lastname: DeJong
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rodean
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.forename: Troy
authors.initials: T
authors.lastname: Richardson
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000191:economics* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003248:Constipation / Q000191:economics / Q000628:therapy*; D003695:Delivery of Health Care / Q000191:economics*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid; D000071069:Multiple Chronic Conditions; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D012189:Retrospective Studies; D014481:United States