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Home Health Care Utilization in Children With Medicaid
Sarah A Sobotka1, David E Hall2, Cary Thurm3
1Department of Pediatrics, Section of Developmental and Behavioral Pediatrics, University of Chicago, Chicago, Illinois.
Insights
Pediatric home health care (HHC) serves diverse children, including infants and those with complex conditions. Technology-assisted care drives most HHC spending, highlighting the need to understand non-nurse caregiver roles.
Area of Science:
- Pediatric Healthcare
- Health Services Research
Background:
- Home health care (HHC) is vital for many children with medical complexity (CMC).
- Limited understanding exists regarding the characteristics of all pediatric HHC recipients, providers, and associated costs.
Purpose of the Study:
- To characterize pediatric HHC recipients, including their clinical profiles.
- To identify the types of providers delivering HHC to children.
- To analyze payment structures for pediatric HHC services.
Main Methods:
- Retrospective analysis of 5,209,525 children (0-17 years) enrolled in Medicaid in 2016.
- Utilized IBM Watson MarketScan Medicaid Database.
- Identified HHC utilizers via claims and codified provider types (RN, LPN, HHA, CNA, companion/personal attendant) using HCPCS and CPT codes.
Main Results:
- 0.8% of children used HHC; 43.8% were infants (<1 year).
- Technology-assisted care (e.g., tracheostomy) represented 15.5% of HHC users but drove 72.6% of HHC spending.
- Registered nurse/licensed practical nurse (RN/LPN) care was most common (45%), particularly for technology-assisted cases (77.2%).
Conclusions:
- Pediatric HHC recipients form a heterogeneous group with varied care needs.
- A diverse range of providers deliver HHC, with nurses being predominant.
- Further research is needed on non-nurse caregivers, especially for children with medical complexity.
Background:
Although many children with medical complexity (CMC) use home health care (HHC), little is known about all pediatric HHC utilizers. Our objective was to assess characteristics of pediatric HHC recipients, providers, and payments.
Methods:
We conducted a retrospective analysis of 5 209 525 children age 0-to-17 years enrolled Medicaid in the 2016 IBM Watson MarketScan Medicaid Database. HHC utilizers had ≥ 1 HHC claim. Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes were reviewed to codify provider types when possible: registered nurse (RN), licensed practical nurse (LPN), home health aide (HHA), certified nursing assistant (CNA), or companion/personal attendant. Enrollee clinical characteristics, HHC provider type, and payments were assessed. Chronic conditions were evaluated with Agency for Healthcare Research and Quality's Chronic Condition Indicators and Feudtner's Complex Chronic Conditions.
Results:
Of the 0.8% of children who used HHC, 43.8% were age <1 year, 25% had no chronic condition, 38.6% had a noncomplex chronic condition, 21.5% had a complex chronic condition without technology assistance, and 15.5% had technology assistance (eg, tracheostomy). HHC for children with technology assistance accounted for 72.6% of all HHC spending. Forty-five percent of HHC utilizers received RN/LPN-level care, 7.9% companion/personal attendant care, 5.9% HHA/CNA-level care, and 36% received care from an unspecified provider. For children with technology assistance, the majority (77.2%) received RN/LPN care, 17.5% companion/personal assistant care, and 13.8% HHA/CNA care.
Conclusions:
Children using HHC are a heterogeneous population who receive it from a variety of providers. Future investigations should explore the role of nonnurse caregivers, particularly with CMC.
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