WIP 88 - Care Continuity and Days at Home among Medicaid-Enrolled Children with Medical Complexity

Publication Number: WIP 88.7525

Caleb Easterly, UNC Chapel Hill, Chapel Hill, NC, United States; Angela Xiong, Duke University School of Medicine, Durham, NC, United States; Laura Stilwell, Duke University School of Medicine, Durham, NC, United States; Justin G. Trogdon, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; David Ming, Duke University School of Medicine, Durham, NC, United States; Neal A. deJong, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States

Background: Continuity of care (CoC) in pediatrics reflects the consistency of a child’s care with the same providers over time. Low CoC is linked to higher emergency department use in both the general pediatric population and among children with medical complexity (CMC). Days at home (DAH) is a promising family-centered measure that emphasizes the value of home time for children and their families. Our prior work shows CMC experience fewer annual DAH than non-CMC populations. However, CoC’s association with DAH among CMC is unknown. We hypothesize that CMC with greater CoC have more days at home, driven by reduced acute care use.

Objective: To examine associations between CoC and DAH among publicly insured CMC in North Carolina (NC).

Design/Methods: This retrospective cohort study uses 2016-2019 institutional and professional claims data from NC Medicaid/Children’s Health Insurance Program. The UNC IRB deemed the study exempt. CMC were identified with the Pediatric Medical Complexity Algorithm (PMCA) Version 3.2. Our analytic sample consists of 211,252 beneficiary-years among CMC aged 1-17 years who (i) were continuously enrolled in Medicaid for 12 months with a maximum 30-day enrollment gap and (ii) had 4+ primary care visits (required for stability of the CoC index). We will apply the Bice-Boxerman Continuity of Care index adapted for CMC (Arthur, et al., Academic Pediatrics, 2018). As in our previous work, we will calculate annual DAH as 365 minus the number of days with an inpatient or outpatient medical encounter. To assess the DAH-CoC association, we will use a generalized linear model and adjust for beneficiary age, age squared, sex, race/ethnicity, rurality of residence, and health status (proxied by indicators for each organ system affected by chronic medical conditions). The analysis will be completed by February 2025. Results will provide important insight into whether improving continuity of care could increase time spent at home and out of medical care settings among CMC, leading to better quality of life and reducing medical care strain for CMC and their families.