Health Care Utilization for Children in Foster Care

Colleen E Bennett; Joanne N Wood; Philip V Scribano

doi:10.1016/j.acap.2019.10.004

Health Care Utilization for Children in Foster Care

Acad Pediatr. 2020 Apr;20(3):341-347. doi: 10.1016/j.acap.2019.10.004. Epub 2019 Oct 14.

Authors

Colleen E Bennett¹, Joanne N Wood², Philip V Scribano³

Affiliations

¹ Division of General Pediatrics, The Children's Hospital of Philadelphia (CE Bennett, JN Wood, and PV Scribano), Philadelphia, Pa; National Clinician Scholars Program, University of Pennsylvania (CE Bennett), Philadelphia, Pa; Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial Penn Center (CE Bennett and JN Wood), Philadelphia, Pa. Electronic address: bennettc1@email.chop.edu.
² Division of General Pediatrics, The Children's Hospital of Philadelphia (CE Bennett, JN Wood, and PV Scribano), Philadelphia, Pa; Leonard Davis Institute of Health Economics, University of Pennsylvania, Colonial Penn Center (CE Bennett and JN Wood), Philadelphia, Pa; Center for Pediatric Clinical Effectiveness and PolicyLab, The Children's Hospital of Philadelphia (JN Wood), Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (JN Wood and PV Scribano), Philadelphia, Pa.
³ Division of General Pediatrics, The Children's Hospital of Philadelphia (CE Bennett, JN Wood, and PV Scribano), Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (JN Wood and PV Scribano), Philadelphia, Pa.

PMID: 31622784
DOI: 10.1016/j.acap.2019.10.004

Abstract

Objective: To utilize hospital EMR data for children placed in foster care (FC) and a matched control group to compare: 1) health care utilization rates for primary care, subspecialty care, emergency department (ED) visits, and hospitalizations; 2) overall charges per patient-year; and 3) prevalence of complex chronic conditions (CCC) and their effect on utilization.

Methods: Children ≤18 years old with a designation of FC placement and controls matched on age, race/ethnicity, gender, and zip code who had an encounter at an urban pediatric health system between 7/1/11 and 6/30/12 were identified in the EMR. Data on outpatient, ED, and inpatient encounters and charges for 7/1/12 to 6/30/13 were obtained. A general linear mixed-effects model was applied to estimate means and rates for each group. Analyses were repeated among the subpopulations of children with and without CCCs.

Results: A total of 1156 FC cases were matched to 4062 controls (mean = 3.5 controls/case). FC cases had significantly higher rates (per 100 patient-years) of hospitalizations (18.5 vs 12.7, P = .005), and subspecialty visits (173.3 vs 113.6; P < .001) but not ED (50.4 vs 45.2, P = .056) or primary care visits (154.6 vs 149.8; P = .50). FC cases had higher charges ($14,372 vs $7082; P < .001). Among children with CCCs, health care utilization rates and charges were higher among FC cases (all P < .001). Among children without CCC, rates and charges were similar for FC cases and controls (all P > .20).

Conclusions: FC children utilized more hospitalizations and subspecialty office visits. The increased utilization rates and charges among children in FC were driven by the subset of children with CCCs.

Keywords: care coordination; complex chronic conditions; foster care; health care utilization.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Case-Control Studies
Child
Child, Foster / statistics & numerical data*
Child, Preschool
Emergency Service, Hospital / statistics & numerical data*
Female
Foster Home Care
Hospitalization / statistics & numerical data*
Humans
Infant
Male
Medicaid
Patient Acceptance of Health Care
Philadelphia
Retrospective Studies
United States
Urban Population