Pediatric Medical Subspecialist Use in Outpatient Settings.

Area of Science:

• Pediatric Health Services Research
• Health Economics
• Public Health

Background:

• Understanding pediatric medical subspecialty care utilization is crucial for assessing healthcare needs.
• Describing current use rates and temporal trends provides a baseline for evaluating service delivery.

Purpose of the Study:

• To quantify the rates of outpatient pediatric medical subspecialty use among children.
• To analyze trends in subspecialty care utilization over time.

Main Methods:

• A repeated cross-sectional study utilizing three data sources: PEDSnet (electronic health records), Healthcare Integrated Research Database (HIRD) (commercial insurance), and Transformed Medicaid Statistical Information System (T-MSIS) (Medicaid).
• Examined annual outpatient visits to pediatric medical subspecialists per population for children younger than 21 years.
• Included large patient cohorts from academic medical centers, commercial health plans, and state Medicaid programs.

Main Results:

• Annual subspecialty care use rates were 21.3% in PEDSnet, 10.4% in HIRD, and 8.6% in T-MSIS.
• Subspecialist use saw a modest annual increase in commercial health plans (2.4%) but remained relatively flat in academic health systems and decreased slightly among Medicaid beneficiaries (-0.9%).
• Disparities in utilization were observed across different insurance types.

Conclusions:

• Significant variation exists in pediatric medical subspecialty care use based on insurance coverage.
• Trends suggest a slight increase in use for commercially insured children, contrasting with a decrease for Medicaid beneficiaries.
• These findings underscore the need for innovations at the primary-specialty care interface to ensure equitable access.