Reliance on Acute Care Settings for Health Care Utilization

OBJECTIVE: Because a goal of the Affordable Care Act was to increase preventive care and reduce high cost care, the objective of this study was to evaluate current healthcare utilization and reliance on acute care settings among Medicaid-enrolled children. METHODS: This was a retrospective cohort study of the 2015 Truven Marketscan Medicaid claims database among children 0-21 years old with at least 11 months of continuous enrollment. We calculated adjusted probabilities of healthcare utilization (any healthcare use and ≥ 1 health maintenance visit) and high acute care reliance (ratio of emergency department or urgent care visits to all health care visits > 0.33) by age and compared utilization between adolescents and younger children using multivariable logistic regression. RESULTS: Of the 5,182,540 Medicaid-enrolled children, 18.9% had no healthcare visits and 47.3% had ≥1 health maintenance visit in 2015. Both healthcare use and health maintenance visits decreased with increasing age (p<0.001). Compared to younger children (0-10 years old), adolescents were more likely to have no interaction with the healthcare system (aOR 2.20; 95% CI 2.19, 2.21) and less likely to have health maintenance visits (aOR 0.40; 0.39, 0.40). High acute care reliance was associated with increasing age, with adolescents having greater odds of high acute care reliance (aOR 1.08 [1.08, 1.09]). CONCLUSIONS: Medicaid-enrolled adolescents have low rates of healthcare utilization and have high reliance on acute care settings. Further investigation into adolescent-specific barriers to health maintenance care and drivers for acute care is warranted

Substance Use Disorder Visits Among Adolescents at Children\u27s Hospitals During COVID-19

PURPOSE: To assess changes in adolescent visits with substance use disorders (SUDs) at children\u27s hospitals during COVID-19. METHODS: We conducted a retrospective cohort study of adolescents (11-18 years) with SUD diagnoses during a hospital visit in the Pediatric Health Information System. Study periods were defined as spring (03/15-05/31), summer (06/01-08/31), and fall (09/01-12/31), pre-COVID-19 (2017-2019), or during COVID-19 (2020). We summarized the change in weekly median visits and interquartile range (IQR) by characteristics and compared between the two periods (e.g., spring pre-COVID-19 [3/15-05/31/2017-2019] versus spring COVID-19 [3/15-05/31/2020]) using median regression. RESULTS: There were 42,979 SUD visits (10,697 COVID-19; 32,282 pre-COVID-19) and 256 annual weekly median adolescent SUD visits [IQR 235, 280] pre-COVID-19 and 268 [IQR 245, 278] during COVID-19. The median number of weekly SUD visits increased by 14.3% during summer COVID-19 (median visits, [IQR]: 272 [268, 278]) compared to pre-COVID-19 (median visits: 237, IQR [216, 249]; p \u3c .001) but did not significantly differ in spring (p = .091) or fall (p = .65) COVID-19. DISCUSSION: Our findings suggest increased problematic adolescent substance use during summer COVID-19. Efforts to increase the identification and treatment of adolescent SUDs remain critical

Acute Care Utilization and Health Care Expenditures in Medicaid-Enrolled Children

OBJECTIVES: Although recent health care reform efforts have focused on minimizing high cost health care utilization, the relationship between acute care use and health care expenditures among certain vulnerable populations such as Medicaid-insured children remains poorly understood. We sought to evaluate the association between acute care utilization and health care expenditures and to identify characteristics associated with high spending. METHODS: We performed a retrospective cohort study of Medicaid-enrolled children 1-21 years old from 1/1/2016 to 12/31/2016. Children were categorized by acute care use (including emergency department and urgent care visits) as 0, 1, 2, 3, and 4 or more visits. Our main outcomes were annualized spending, total per-member-per-year spending, and acute care-related per-member-per-year spending. RESULTS: There were 5.1 million Medicaid-enrolled children that comprised the study cohort, accounting for US $32.6 billion in total spending. Children with 4 or more acute care visits were more likely to be younger than 2 years or older than 14 years, female, and have a chronic condition. Children with 4 or more acute care visits consisted of only 4$4.7 billion) of the total spending. Increasing acute care visits were associated with increasing total annualized spending in adjusted analyses (P \u3c 0.001). This association was disproportionately observed in older age groups and children without chronic medical conditions. CONCLUSIONS: Medicaid spending for children increases with increasing acute care use; this trend was disproportionately observed in older age groups and children without chronic medical conditions. Improved understanding of factors contributing to frequent acute care utilization and disproportionate spending is needed to potentially reduce unnecessary health care costs in these pediatric populations

Timing of malaria infection during pregnancy has characteristic maternal, infant and placental outcomes.

We conducted a clinical study of pregnant women in Blantyre, Malawi to determine the effect of the timing of malaria infection during pregnancy on maternal, infant and placental outcomes. Women were enrolled in their first or second trimester of their first or second pregnancy and followed every four weeks until delivery. Three doses of sulfadoxine-pyrimethamine were given for intermittent preventive treatment for malaria, and all episodes of parasitemia were treated according to the national guidelines. Placentas were collected at delivery and examined for malaria parasites and pigment by histology. Pregnant women had 0.6 episodes of malaria per person year of follow up. Almost all episodes of malaria were detected at enrollment and malaria infection during the follow up period was rare. Malaria and anemia at the first antenatal visit were independently associated with an increased risk of placental malaria detected at delivery. When all episodes of malaria were treated with effective antimalarial medication, only peripheral malaria infection at the time of delivery was associated with adverse maternal and infant outcomes. One quarter of the analyzed placentas had evidence of malaria infection. Placental histology was 78% sensitive and 89% specific for peripheral malaria infection during pregnancy. This study suggests that in this setting of high antifolate drug resistance, three doses of sulfadoxine-pyrimethamine maintain some efficacy in suppressing microscopically detectable parasitemia, although placental infection remains frequent. Even in this urban setting, a large proportion of women have malaria infection at the time of their first antenatal care visit. Interventions to control malaria early and aggressive case detection are required to limit the detrimental effects of pregnancy-associated malaria

Number of participants with malaria during each trimester.

<p>Number of participants with malaria during each trimester.</p