Specialist use among privately insured children with disabilities.

Autor: Chien AT; Division of General Pediatrics, Department of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA., Wisk LE; Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA., Beaulieu N; Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA., Houtrow AJ; Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA., Van Cleave J; Department of Pediatrics, University of Colorado School of Medicine, Anshutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado, USA., Fu C; Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA., Cutler D; Department of Economics, Harvard University, National Bureau of Economic Research, Cambridge, Massachusetts, USA., Landrum MB; Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Health services research [Health Serv Res] 2024 Aug; Vol. 59 (4), pp. e14199. Date of Electronic Publication: 2023 Jul 17.
DOI: 10.1111/1475-6773.14199
Abstrakt: Objective: To investigate primary care practice ownership and specialist-use patterns for commercially insured children with disabilities.
Data Sources and Study Setting: A national commercial claims database and the Health Systems and Provider Database from 2012 to 2016 are the data sources for this study.
Study Design: This cross-sectional, descriptive study examines: (1) the most visited type of pediatric primary care physician and practice (independent or system-owned); (2) pediatric and non-pediatric specialist-use patterns; and (3) how practice ownership relates to specialist-use patterns.
Data Collection/extraction Methods: This study identifies 133,749 person-years of commercially insured children with disabilities aged 0-18 years with at least 24 months of continuous insurance coverage by linking a national commercial claims data set with the Health Systems and Provider Database and applying the validated Children with Disabilities Algorithm.
Principal Findings: Three-quarters (75.9%) of children with disabilities received their pediatric primary care in independent practices. Nearly two thirds (59.6%) used at least one specialist with 45.1% using nonpediatric specialists, 28.8% using pediatric ones, and 17.0% using both. Specialist-use patterns varied by both child age and specialist type. Children with disabilities in independent practices were as likely to see a specialist as those in system-owned ones: 57.1% (95% confidence interval [95% CI] 56.7%-57.4%) versus 57.3% (95% CI 56.6%-58.0%), respectively (p = 0.635). The percent using two or more types of specialists was 46.1% (95% CI 45.4%-46.7%) in independent practices, comparable to that in systems 47.1% (95% CI 46.2%-48.0%) (p = 0.054). However, the mean number of specialist visits was significantly lower in independent practices than in systems-4.0 (95% CI 3.9%-4.0%) versus 4.4 (95% CI 4.3%-4.6%) respectively-reaching statistical significance with p < 0.0001.
Conclusions: Recognizing how privately insured children with disabilities use pediatric primary care from pediatric and nonpediatric primary care specialists through both independent and system-owned practices is important for improving care quality and value.
(© 2023 Health Research and Educational Trust.)
Databáze: MEDLINE
Externí odkaz: