Medical home access and health care use and expenditures among children with special health care needs

Melissa A. Romaire, Janice F Bell, David C. Grossman

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Objective: To test associations between having a medical home and health services use and expenditures among US children with special health care needs (CSHCN). Design: Cross-sectional analysis. Setting: The 2003-2008 Medical Expenditure Panel Surveys. Participants: A total of 9816 CSHCN up to 17 years, including 1056 with a functional or sensory limitation and 8760 without a limitation. Main Exposure: Parent or caregiver report of CSHCN having a medical home. Main Outcome Measures: We examined CSHCN's annual use of outpatient, inpatient, emergency department, and dental visits, and annual outpatient, inpatient, emergency department, prescription medication, dental, and other health care expenditures. Results: CSHCN with a medical home had 14% more dental visits compared with CSHCN without a medical home (incidence rate ratio [IRR], 1.14; 95% CI, 1.03-1.25); this finding is significant for CSHCN without limitations but not for those with limitations. The medical home was associated with greater odds of incurring total, outpatient, prescription medication, and dental expenditures (odds ratio range, 1.25-1.92). Among CSHCN with a limitation, children with a medical home had lower annual inpatient expenditures compared with those without a medical home (mean, -$968; 95% CI, -$121 to -$1928), and among CSHCN without a limitation, children with a medical home had higher annual prescription medication expenditures compared with those without a medical home (mean, $87; 95% CI, $22-$153). Conclusions: There were few differences in annual health services use and expenditures between CSHCN with and without a medical home. However, the medical home may be associated with lower inpatient expenditures and higher prescription medication expenditures within subgroups of CSHCN.

Original languageEnglish (US)
Pages (from-to)323-330
Number of pages8
JournalArchives of Pediatrics and Adolescent Medicine
Volume166
Issue number4
DOIs
StatePublished - Apr 2012
Externally publishedYes

Fingerprint

Patient-Centered Care
Home Care Services
Health Expenditures
Delivery of Health Care
Prescriptions
Inpatients
Tooth
Outpatients
Health Services
Hospital Emergency Service
Caregivers
Cross-Sectional Studies
Odds Ratio

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Medical home access and health care use and expenditures among children with special health care needs. / Romaire, Melissa A.; Bell, Janice F; Grossman, David C.

In: Archives of Pediatrics and Adolescent Medicine, Vol. 166, No. 4, 04.2012, p. 323-330.

Research output: Contribution to journalArticle

@article{ae432636f00b430f972483f7ca293e76,
title = "Medical home access and health care use and expenditures among children with special health care needs",
abstract = "Objective: To test associations between having a medical home and health services use and expenditures among US children with special health care needs (CSHCN). Design: Cross-sectional analysis. Setting: The 2003-2008 Medical Expenditure Panel Surveys. Participants: A total of 9816 CSHCN up to 17 years, including 1056 with a functional or sensory limitation and 8760 without a limitation. Main Exposure: Parent or caregiver report of CSHCN having a medical home. Main Outcome Measures: We examined CSHCN's annual use of outpatient, inpatient, emergency department, and dental visits, and annual outpatient, inpatient, emergency department, prescription medication, dental, and other health care expenditures. Results: CSHCN with a medical home had 14{\%} more dental visits compared with CSHCN without a medical home (incidence rate ratio [IRR], 1.14; 95{\%} CI, 1.03-1.25); this finding is significant for CSHCN without limitations but not for those with limitations. The medical home was associated with greater odds of incurring total, outpatient, prescription medication, and dental expenditures (odds ratio range, 1.25-1.92). Among CSHCN with a limitation, children with a medical home had lower annual inpatient expenditures compared with those without a medical home (mean, -$968; 95{\%} CI, -$121 to -$1928), and among CSHCN without a limitation, children with a medical home had higher annual prescription medication expenditures compared with those without a medical home (mean, $87; 95{\%} CI, $22-$153). Conclusions: There were few differences in annual health services use and expenditures between CSHCN with and without a medical home. However, the medical home may be associated with lower inpatient expenditures and higher prescription medication expenditures within subgroups of CSHCN.",
author = "Romaire, {Melissa A.} and Bell, {Janice F} and Grossman, {David C.}",
year = "2012",
month = "4",
doi = "10.1001/archpediatrics.2011.1154",
language = "English (US)",
volume = "166",
pages = "323--330",
journal = "JAMA Pediatrics",
issn = "2168-6203",
publisher = "American Medical Association",
number = "4",

}

TY - JOUR

T1 - Medical home access and health care use and expenditures among children with special health care needs

AU - Romaire, Melissa A.

AU - Bell, Janice F

AU - Grossman, David C.

PY - 2012/4

Y1 - 2012/4

N2 - Objective: To test associations between having a medical home and health services use and expenditures among US children with special health care needs (CSHCN). Design: Cross-sectional analysis. Setting: The 2003-2008 Medical Expenditure Panel Surveys. Participants: A total of 9816 CSHCN up to 17 years, including 1056 with a functional or sensory limitation and 8760 without a limitation. Main Exposure: Parent or caregiver report of CSHCN having a medical home. Main Outcome Measures: We examined CSHCN's annual use of outpatient, inpatient, emergency department, and dental visits, and annual outpatient, inpatient, emergency department, prescription medication, dental, and other health care expenditures. Results: CSHCN with a medical home had 14% more dental visits compared with CSHCN without a medical home (incidence rate ratio [IRR], 1.14; 95% CI, 1.03-1.25); this finding is significant for CSHCN without limitations but not for those with limitations. The medical home was associated with greater odds of incurring total, outpatient, prescription medication, and dental expenditures (odds ratio range, 1.25-1.92). Among CSHCN with a limitation, children with a medical home had lower annual inpatient expenditures compared with those without a medical home (mean, -$968; 95% CI, -$121 to -$1928), and among CSHCN without a limitation, children with a medical home had higher annual prescription medication expenditures compared with those without a medical home (mean, $87; 95% CI, $22-$153). Conclusions: There were few differences in annual health services use and expenditures between CSHCN with and without a medical home. However, the medical home may be associated with lower inpatient expenditures and higher prescription medication expenditures within subgroups of CSHCN.

AB - Objective: To test associations between having a medical home and health services use and expenditures among US children with special health care needs (CSHCN). Design: Cross-sectional analysis. Setting: The 2003-2008 Medical Expenditure Panel Surveys. Participants: A total of 9816 CSHCN up to 17 years, including 1056 with a functional or sensory limitation and 8760 without a limitation. Main Exposure: Parent or caregiver report of CSHCN having a medical home. Main Outcome Measures: We examined CSHCN's annual use of outpatient, inpatient, emergency department, and dental visits, and annual outpatient, inpatient, emergency department, prescription medication, dental, and other health care expenditures. Results: CSHCN with a medical home had 14% more dental visits compared with CSHCN without a medical home (incidence rate ratio [IRR], 1.14; 95% CI, 1.03-1.25); this finding is significant for CSHCN without limitations but not for those with limitations. The medical home was associated with greater odds of incurring total, outpatient, prescription medication, and dental expenditures (odds ratio range, 1.25-1.92). Among CSHCN with a limitation, children with a medical home had lower annual inpatient expenditures compared with those without a medical home (mean, -$968; 95% CI, -$121 to -$1928), and among CSHCN without a limitation, children with a medical home had higher annual prescription medication expenditures compared with those without a medical home (mean, $87; 95% CI, $22-$153). Conclusions: There were few differences in annual health services use and expenditures between CSHCN with and without a medical home. However, the medical home may be associated with lower inpatient expenditures and higher prescription medication expenditures within subgroups of CSHCN.

UR - http://www.scopus.com/inward/record.url?scp=84859402626&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84859402626&partnerID=8YFLogxK

U2 - 10.1001/archpediatrics.2011.1154

DO - 10.1001/archpediatrics.2011.1154

M3 - Article

C2 - 22147757

AN - SCOPUS:84859402626

VL - 166

SP - 323

EP - 330

JO - JAMA Pediatrics

JF - JAMA Pediatrics

SN - 2168-6203

IS - 4

ER -