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

Days at home (DAH; days without a medical encounter) is a patient- and family-centered measure that has not been used among children with medical complexity (CMC). Our objective was to pilot the DAH measure among CMC and compare DAH between those insured by private and public insurance plans.

This retrospective cohort study used 2017-2019 medical claims data from NC Medicaid/Children's Health Insurance Program and a large NC-based private insurer. Beneficiary-years were included for beneficiaries aged 1-20 years and continuously enrolled for 12 months. CMC were identified with the Pediatric Medical Complexity Algorithm. Annual DAH was calculated as 365 minus the number of days with any medical encounter. We evaluated how adjusted DAH varied by medical complexity, payer, and urban/rural residence.

Compared to children without chronic disease, CMC insured by Medicaid and private insurance had 17.6 (99.9% CI: 17.4, 17.7) and 15.9 (99.9% CI: 15.4, 16.4) fewer DAH, respectively. Medicaid-insured CMC had 2.92 fewer annual DAH than privately insured CMC after adjusting for age, sex, and rurality, though this decreased to 0.45 fewer annual DAH after additionally adjusting for body systems affected by the health condition(s). Both privately and publicly insured CMC living in rural areas had more DAH than those living in large metropolitan areas.

CMC have fewer DAH than children without chronic disease. Differences in DAH by payer and rurality could be due to disease severity, differential access to medical care, or variation in the quality of health care obtained by children and their families.