Effect of Having a Usual Source of Care on Health Care Outcomes Among Children With Serious Emotional Disturbance

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• 作者：Whitney P. Witt ; PhD ; MPH^a ; ^{whitney.witt@truvenhealth.com} ; Catherine A. Fullerton ; MD ; MPH^b ; Clifton Chow ; PhD^d ; Manjusha Gokhale ; MA^b ; Sarah Naeger ; PhD ; MPH^c ; ^e ; Christine Walsh ; BA^c ; Lucy Karnell ; PhD^c
• 关键词：health care quality ; health care spending ; health care utilization ; serious emotional disturbance ; usual source of care
• 刊名：Academic Pediatrics
• 出版年：2017
• 出版时间：January-February 2017
• 年：2017
• 卷：17
• 期：1
• 页码：45-52
• 全文大小：191 K
• 卷排序：17

文摘

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).MethodsAdministrative 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.ResultsPropensity 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.ConclusionsHaving 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.