WIP 68 - Post-Injury Physical and Mental Health Care for Children Living in Health Care Deserts

Publication Number: WIP 68.7515

Camille Vu, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Silver Spring, MD, United States; Sarah Prabhakar, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Ian S. Sorensen, Henry M Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, United States; Kalyn C. Jannace, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Rebecca N. Schulz, Henry M. Jackson Foundation, Rockville, MD, United States; Siddarth Sharma, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Elizabeth Hisle-Gorman, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States

Background: Limited health care access is a social determinant of health that can negatively impact children long-term. The majority of rural counties in the U.S. are health care deserts, requiring more than 60 minutes to travel to reach an acute-care facility. The effect of living in a health care desert on rates of physical and mental health care for children post-injury is unknown.

Objective: The aim is to examine the effect of living in a primary care and/or mental health care desert on rates of physical and mental health care for children post-injury.

Design/Methods: The Military Health System Data Repository from 2005-2015 will be used to conduct a retrospective cohort study comparing rates of physical and mental health (MH) care for approximately 103,000 children (2-17 years old) within one year post-injury. The children have a parent or guardian who is an Active Duty military member (sponsor). The Defense Medical Information System Identifier (DMIS ID) will be used to identify children who are assigned to medical care at a military base in primary care and/or MH care deserts, and those who are not. Provider specialty will be used to identify inpatient and outpatient physical and MH care encounters. International Classification of Diseases (ICD-9) codes in the medical record will identify children with diagnoses of blindness, burns, concussion, fracture, major limb loss, multiple significant trauma, other MH injury, post-traumatic stress disorder, shrapnel injury, and spinal cord injury. Poisson regression will calculate unadjusted and adjusted rates of physical and MH care, comparing those in and out of a health care desert, and stratifying by injury type. Models will be adjusted for age, sex, sponsor race, and sponsor rank (socioeconomic status surrogate). Heat maps will be created to show rates of care by area, identifying which ones are health care deserts. Institutional Review Board approval has been acquired. Writing the code for access to care in different areas will be completed by January 2025. Results and data analysis will be accomplished by February 2025.