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Patterns of health care use that may identify young children who are at risk for maltreatment
Eron Y Friedlaender1, David M Rubin, Elizabeth R Alpern
1Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. friedlaender@email.chop.edu
Insights
Children at risk for maltreatment frequently change their primary care providers before diagnosis. This pattern may aid in the early identification of child abuse and neglect.
Area of Science:
- Pediatrics
- Child Abuse and Neglect
- Healthcare Services Research
Background:
- Early identification of children at risk for maltreatment remains a significant challenge for healthcare providers.
- Understanding pre-diagnosis healthcare utilization patterns can potentially distinguish at-risk children.
Purpose of the Study:
- To determine if children at risk for maltreatment exhibit distinct healthcare utilization patterns in the year preceding abuse or neglect diagnosis.
- To identify specific healthcare use indicators that differentiate maltreated children from their peers.
Main Methods:
- A case-control study was conducted using Medicaid-enrolled children.
- Compared healthcare service use in the year before a substantiated maltreatment report (leading to foster care placement) with matched controls.
- Analyzed variables including outpatient visits, emergency department visits, injury diagnoses, nonspecific diagnoses, and primary care provider changes, adjusting for covariates.
Main Results:
- Maltreated children were significantly more likely to experience changes in their primary care provider (2+ changes: 6.87 times more likely) in the year before their first maltreatment report.
- No significant differences were observed in emergency department visit frequency or rates of injury/nonspecific diagnoses between cases and controls.
- Sixteen percent of maltreated children changed primary care providers compared to 10% of controls.
Conclusions:
- Children experiencing substantiated abuse or neglect demonstrate a higher frequency of ambulatory care provider changes compared to non-abused children.
- Recognizing frequent primary care provider changes may serve as an early indicator for identifying children at risk of maltreatment.
- This finding offers a potential clinical marker for earlier intervention and prevention strategies.
Objectives:
Early identification of children who are at risk for maltreatment continues to pose a challenge to the medical community. The objective of this study was to determine whether children who are at risk for maltreatment have characteristic patterns of health care use before their diagnosis of abuse or neglect that distinguish them from other children.
Methods:
We performed a case-control study among Medicaid-enrolled children to compare patterns of health service among maltreated children in the year before a first report for abuse or neglect that led to an immediate placement into foster care, with patterns of health service use among matched control subjects. Exposure variables, obtained from Medicaid claims, included the total number of non-emergency department (ED) outpatient visits, the total number of ED visits, the frequency of injury-related diagnoses, the frequency of nonspecific diagnoses that have been previously linked to abuse, and the number of changes in a child's primary care provider. Multivariate models were performed adjusting for cash assistance eligibility, race, and child comorbidities.
Results:
We characterized the health service use patterns, during the year before their first maltreatment report, of 157 children with serious and substantiated abuse or neglect. Health service use during the same period was also characterized among 628 control subjects who were matched by age, gender, and number of months of Medicaid eligibility. Sixteen percent of cases changed their primary care providers, compared with 10% of the control subjects. Multivariable modeling demonstrated that maltreated children were 2.62 (95% confidence interval: 1.40-4.91) times more likely than control subjects to have had 1 previous change in primary care provider and 6.87 (95% confidence interval: 1.96-24.16) times more likely to have changed providers 2 or more times during the year before their first maltreatment report. There were no differences between case patients and control subjects in the frequency of ED visits and rates of diagnoses of injury or nonspecific somatic complaints.
Conclusions:
Victims of serious and substantiated physical abuse and neglect change ambulatory care providers with greater frequency than nonabused children. Recognition of this patient characteristic may allow for earlier identification of children who are at risk for additional or future maltreatment.
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