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Children with medical complexity (CMC) in Montana generally live closer to specialists. However, American Indian children with CMC face greater distances to specialty care, highlighting access disparities.

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Area of Science:

  • Pediatric Healthcare Access
  • Health Disparities Research
  • Rural Health

Background:

  • Children with medical complexity (CMC) represent a vulnerable population requiring specialized care.
  • Geographic barriers and race can significantly impact access to pediatric subspecialty services.
  • Understanding the distribution of CMC and their access to care in rural states like Montana is crucial.

Purpose of the Study:

  • To characterize children with medical complexity (CMC) in Montana based on clinical factors, rurality, and proximity to specialty care.
  • To identify and quantify disparities in geographic access to pediatric subspecialty care for American Indian children.

Main Methods:

  • A cross-sectional study utilizing 2016-21 Montana Medicaid claims data.
  • Children were categorized using the Pediatric Medical Complexity Algorithm.
  • Drive times to nearest pediatric subspecialists were calculated, with comparisons made based on complexity and race.

Main Results:

  • Out of 126,873 children, 8.5% were identified as CMC.
  • CMC had shorter median drive times (28 minutes) compared to noncomplex chronic (34 minutes) and no chronic conditions (43 minutes).
  • American Indian children, irrespective of complexity, consistently lived farther from specialists than other racial groups.

Conclusions:

  • While CMC may live closer to specialists overall, significant numbers still face long travel distances.
  • American Indian children experience greater geographic barriers to specialty care, regardless of their medical complexity.
  • Future interventions should prioritize improving access for rural and American Indian CMC.