Days at Home Among Children by Medical Complexity, Public/Private Insurance, and Urban/Rural Residence

Area of Science:

• Pediatric Health Services Research
• Health Outcomes
• Medical Economics

Background:

• Days at home (DAH) is a patient-centered metric for children with medical complexity (CMC).
• The DAH measure has not been widely adopted or studied in CMC populations.
• Understanding DAH differences by insurance type is crucial for equitable care.

Purpose of the Study:

• To pilot the DAH measure in a CMC population.
• To compare DAH between CMC insured by public (Medicaid) versus private insurance plans.
• To explore DAH variations based on medical complexity, insurance, and geographic residence.

Main Methods:

• Retrospective cohort study using 2017-2019 medical claims data.
• Included continuously enrolled beneficiaries aged 1-20 years.
• Identified CMC using the Pediatric Medical Complexity Algorithm and calculated annual DAH.

Main Results:

• CMC had significantly fewer DAH compared to children without chronic diseases.
• Medicaid-insured CMC had fewer DAH than privately insured CMC, with differences narrowing after adjusting for health conditions.
• CMC in rural areas had more DAH than those in urban areas, irrespective of insurance type.

Conclusions:

• CMC experience fewer days at home, indicating a higher burden of medical care.
• Disparities in DAH by insurance and location suggest potential inequities in healthcare access or quality.
• Further research is needed to address the factors influencing DAH in CMC.