Effect of Having a Usual Source of Care on Health Care Outcomes Among Children With Serious Emotional Disturbance.
To determine the influence of a usual source of care (USC) on health care utilization, expenditures, and quality for Medicaid-insured children and adolescents with a serious emotional disturbance (SED).



Administrative claims data for 2011-2012 were extracted from the Truven Health MarketScan Multi-State Medicaid Research Database for 286,585 children and adolescents with a primary diagnosis of SED. We used propensity score-adjusted multivariate regressions to determine whether having a USC had a significant effect on utilization and expenditures for high-cost services that are considered potentially avoidable with appropriate outpatient care: physical and behavioral health inpatient admissions, emergency department (ED) visits, and hospital readmissions.



Propensity score-adjusted regressions indicated that children with a USC had fewer inpatient admissions related to behavioral health (adjusted odds ratio [AOR] = 0.87; 95% confidence interval [CI], 0.79-0.97) and physical health (AOR = 0.91; 95% CI, 0.89-0.93) and lower expenditures for behavioral health inpatient admissions, physical health ED visits, and readmissions. Having a USC also was associated with a higher likelihood of receiving quality health care for 4 physical health and 2 behavioral health measures.



Having a USC improved the health care of Medicaid-insured children and adolescents with an SED. However, despite having insurance, approximately one-fourth of this patient population did not appear to have a USC. This information can be used in developing programs that encourage connections with comprehensive health care that provides coordination among various providers.
Truven Health Analytics, an IBM Company, Durham, NC. Electronic address: whitney.witt@truvenhealth.com.
Whitney P
WP
Witt
Truven Health Analytics Inc, Cambridge, Mass.
Catherine A
CA
Fullerton
Cambridge Health Alliance, Cambridge, MA.
Clifton
C
Chow
Truven Health Analytics Inc, Cambridge, Mass.
Manjusha
M
Gokhale
Truven Health Analytics Inc, Bethesda, Md; Substance Abuse and Mental Health Services Administration (SAMHSA) Bethesda, MD.
Sarah
S
Naeger
Truven Health Analytics Inc, Bethesda, Md.
Christine
C
Walsh
Truven Health Analytics Inc, Bethesda, Md.
Lucy
L
Karnell
D000293:Adolescent; D000342:Affective Symptoms / Q000453:epidemiology; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid; D001523:Mental Disorders / Q000453:epidemiology*; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D011787:Quality of Health Care; D014481:United States
health care quality; health care spending; health care utilization; serious emotional disturbance; usual source of care