The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

Well-Child Care in Infancy and Healthcare Services Utilization From Birth to 6 Years by Late Preterm Children Receiving Medicaid Benefits

Authors: William B. Pittard III MD, PhD

Abstract

Objectives: The hypotheses tested are that healthy late preterm (LP) children receiving Medicaid benefits use more healthcare services from birth to 6 years than do full-term (FT) children and that those who make the recommended number of early and periodic screening, diagnosis, and treatment (EPSDT) visits in the first 2 years require fewer services than those with fewer visits.


Methods: Data represent all of the health encounters for a 6-year birth cohort (1996–2001) of LP and FT children in South Carolina continuously enrolled in Medicaid birth to 6 years (N = 25,940). Associations were examined between making the recommended number of EPSDT visits in the first 2 years and sick-child office visits, emergency department (ED) visits, hospital admissions and hospitalizations, and ED visits for ambulatory care–sensitive conditions (ACSCs).


Results: LP children used more sick-child office visits and hospital admissions (P < 0.001) from birth to 6 years than FT children. LP children with at least the recommended number of EPSDT visits had a greater adjusted rate of sick-child office visits (rate ratio 1.62, confidence interval 1.30–2.02) and a lower adjusted rate of ACSC ED visits (rate ratio 0.79, confidence interval 0.65–0.96) than those making fewer visits. Making the recommended number of EPSDT visits did not affect rates of non-ACSC ED visits or of hospitalizations.


Conclusions: LP children use more healthcare services in the first 6 years of life than do FT children, and those making the recommended number of EPSDT visits may shift some of their healthcare provision from the ED to providers’ offices.

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References

1. Schor EL, Abrams M, Shea K. Medicaid: health promotion and disease prevention for school readiness. Health Aff (Millwood) 2007; 26: 420–429.
 
2. Pittard WB, Laditka JN, Laditka SB. Associations between early and periodic screening, diagnosis, and treatment and infant health outcomes among Medicaid-insured infants in South Carolina. J Pediatr 2007; 151: 414–418.
 
3. Gavin NI, Adams EK, Herz EJ. The use of EPSDT and other healthcare services by children enrolled in Medicaid: the impact of OBRA ‘89. Milbank Q 1998; 76: 207–232.
 
4. Peterson LA, Burstin HR, O’Neil AC, et al. Non-urgent emergency department visits: the effect of having a regular doctor. Med Care 1998; 36: 1249–1255.
 
5. Rider RV, Taback M, Knobloch H. Associations between premature birth and socioeconomic status.Am J Public Health Nations Health 1955; 45: 1022–1028.
 
6. Farel AM, Kotch JB. The child from 1 to 4: the toddler and preschool years, in Kotch JB (ed):Maternal and Child Health: Programs, Problems and Policy in Public Health. Gaithersburg, MD, Aspen Publishers, 1997; 115–146.
 
7. Raju TN, Higgins RD, Stark AR, et al. Optimizing care and outcome for late preterm (near-term) infants: a summary of the workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics 2006; 118: 1207–1214.
 
8. Bird TM, Bronstein JM, Hall RW, et al. Late preterm infants: birth outcomes and health care utilization in the first year. Pediatrics 2010; 126: e311–e319.
 
9. Mally PV, Bailey S, Hendricks-Muñoz KD. Clinical issues in the management of late preterm infants. Curr Probl Pediatr Adolesc Health Care 2010: 40: 218–233.
 
10. Pulver LS, Denney JM, Silver RM, et al. Morbidity and discharge timing of late preterm newborns. Clin Pediatr (Phila) 2010; 49: 1061–1067.
 
11. Escobar GJ, Greene JD, Hulac P, et al. Rehospitalization after birth hospitalisation: patterns among infants of all gestations. Arch Dis Child 2005; 90: 125–131.
 
12. Raju TN. Late-preterm births: challenges and opportunities. Pediatrics 2008; 121: 402–403.
 
13. Gurka MJ, LoCasale-Crouch J, Blackman JA. Long-term cognition, achievement, socioemotional, and behavioral development of healthy late- preterm infants. Arch Pediatr Adolesc Med 2010; 164: 525–532.
 
14. Chassin MR, Galvin RW. The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. JAMA 1998; 280: 1000–1005.
 
15. Committee on Practice and Ambulatory Medicine and Bright Futures Steering Committee. Recommendations for preventive pediatric health care. Pediatrics 2007; 120: 1376.
 
16. US Congress, Office of Technology Assessment, Committee on Practice and Ambulatory Medicine. Recommendations for preventive pediatric health care. In: Healthy Children: Investing in the Future. OTA-H-345. Washington, DC, US Government Printing Office, 1988.
 
17. Pittard WB III, Laditka SB, Laditka JN, et al. Infant health outcomes differ notably among Medicaid insurance models: evidence of a successful case management program in South Carolina. J S C Med Assoc 2007; 103: 188–193.
 
18. Pittard WB III, Hulsey TC, Laditka JN, et al. School readiness among children insured by Medicaid, South Carolina. Prev Chronic Dis 2012; 9: E111
 
19. Pittard WB III, Laditka JN, Laditka SB. Associations between early and periodic screening, diagnosis, and treatment and health outcomes among Medicaid-insured infants in South Carolina. J Pediatr 2007; 151: 414–418.
 
20. Hakim RB, Bye BV. Effectiveness of compliance with pediatric preventive care guidelines among Medicaid beneficiaries. Pediatrics 2001; 108: 90–97.
 
21. Russell LB. Is Prevention Better than Cure? Washington DC, Brookings Institution, 1986.
 
22. Falik M, Needleman J, Wells BL, et al. Ambulatory care sensitive hospitalizations and emergency visits: experiences of Medicaid patients using federally qualified health centers. Med Care 2001; 39: 551–561.
 
23. South Carolina Budget and Control Board, Office of Research and Statistics. http://ors.sc.gov. Accessed September 26, 2012.
 
24. Klaus MH, Kennel JH. Care of the parents, in Klaus MH, Fanaroff AA (eds): Care of the High Risk Neonate. Philadelphia, WB Saunders, 2001; 189–211.
 
25. Alexander GR, Himes JH, Kaufman RB, et al. A United States national reference for fetal growth. Obstet Gynecol 1996; 87: 163–168.
 
26. Hamilton BE, Martin JA, Sutton PD, et al. Births: preliminary data for 2003. Natl Vital Stat Rep 2004; 53: 1–17.
 
27. Rosenbach ML, Gavin NI. Early and periodic screening, diagnosis, and treatment and managed care. Annu Rev Public Health 1998; 19: 507–525.
 
28. Bethell C, Reuland CH, Halfon N, et al. Measuring the quality of preventive and developmental services for young children: national estimates and patterns of clinicians’ performance. Pediatrics 2004: 113; 1973–1983.
 
29. Shadish WR, Cook TD, Campbell DT. Experimental and Quasi-experimental Designs for Generalized Causal Inference. Boston, Houghton Mifflin, 2002.