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Well-Child Care Disparities in U.S. Military Health System
Laura Hammon1, Lisa Mondzelewski2, Camille Robinson3
1Department of Pediatrics (L Hammon), Naval Hospital Rota, Spain.
Insights
Military children
Area of Science:
- Pediatric health outcomes
- Healthcare access and disparities
- Military family health
Background:
- Well-child visits are crucial for infant development and early detection of health issues.
- Military children often have unique healthcare needs due to frequent relocations and parental deployments.
- Understanding adherence to preventive care guidelines is essential for optimizing child health within the military community.
Purpose of the Study:
- To determine adherence rates for well-child visits in the first 15 months of life among military children.
- To identify demographic and systemic factors associated with disparities in visit adherence.
- To assess adherence within a population with universal health insurance coverage.
Main Methods:
- Retrospective cohort analysis of 168,830 infants using Military Health System data.
- Children born between October 2013 and September 2016 were followed from birth to 15 months.
- Adherence to the Health Effectiveness Data and Information Set (HEDIS) metric of 6 well visits was assessed using logistic regression models.
Main Results:
- Overall adherence rate for well-child visits was 86%, with an average of 6.7 visits.
- Lower adherence was observed in children of junior enlisted personnel, Black children, and those whose sponsors were in the Air Force.
- Enrollment at a single site and care managed by a pediatrician were linked to higher adherence rates.
Conclusions:
- Sponsor rank, race, service branch, provider type, and enrollment site number significantly influenced adherence probability.
- Despite universal insurance, disparities in well-child visit adherence exist among military children.
- Further research is needed to explore barriers to care in this universally insured population.
Objective:
To describe adherence rates for well-child visits among military children in the first 15 months of life and identify any disparities in adherence in a universally insured population.
Methods:
A retrospective cohort analysis was conducted using the Military Health System data repository which included children who were born between October 2013 and September 2016 and were eligible for TRICARE (the military health insurance program). Children were followed from zero to fifteen months of life to assess adherence with a national Health Effectiveness Data and Information Set (HEDIS) metric of 6 well visits during this period. Differences in adherence rates were evaluated across select demographic characteristics including sponsor rank, race, age, service branch, patient sex, geographic region, number of enrollment sites and provider type. Fitted logistic regression models were used to determine the probability of adherence with the HEDIS metric and identify disparities.
Results:
The final cohort included 168,830 infants. Across all variables, the mean number of well visits was 6.7 with an overall adherence rate of 86%. Child beneficiaries of junior enlisted, Black, and Air Force military members had lower adherence with the HEDIS metric. Enrollment at a single site and having a pediatrician for a primary care manager was associated with higher rates of adherence.
Conclusions:
Sponsor rank, race, and service branch, along with provider type and number of enrollment sites were significantly associated with the probability of adherence. Further research should evaluate barriers to care that affect a universally insured population.
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