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Patterns of care received by Medicaid recipients with urinary tract infections
C A Fargason1, J M Bronstein, V A Johnson
1Department of Pediatrics, University of Alabama at Birmingham, USA.
Insights
Physicians underuse urine cultures for pediatric urinary tract infections (UTIs) in Alabama. Urban pediatricians utilized cultures more, but imaging studies were also underused, falling short of recommended guidelines for children.
Area of Science:
- Pediatric healthcare quality
- Infectious disease diagnostics
- Healthcare access and disparities
Background:
- Urinary tract infections (UTIs) are common in children and can lead to significant illness.
- Urine cultures are the recommended diagnostic standard for pediatric UTIs.
- Imaging studies are advised for a subset of children diagnosed with UTIs.
Purpose of the Study:
- To evaluate the performance rates of urine cultures and imaging studies for children diagnosed with UTIs within the Alabama Medicaid program.
- To examine variations in these rates based on patient demographics, provider characteristics, and service locations.
Main Methods:
- Retrospective analysis of Alabama Medicaid claims data from 1991.
- Inclusion criteria: children younger than 8 years with a UTI diagnosis and continuous Medicaid enrollment.
- Classification of physician locations as rural, suburban, or urban; identification of procedures using CPT codes.
Main Results:
- Only 47% of pediatric UTI episodes had associated urine culture claims.
- Urine cultures were more frequently performed by pediatricians in urban settings.
- Among patients with multiple UTI episodes, only 68% received recommended imaging studies, with 44% receiving both voiding cystourethrogram and renal ultrasound.
Conclusions:
- Physician underutilization of urine cultures for diagnosing pediatric UTIs is suggested by claims data in Alabama.
- Pediatricians in urban areas demonstrated higher performance rates for urine cultures compared to other physicians.
- Recommended imaging studies for pediatric UTIs were less frequently employed than guidelines suggest.
Background:
Urinary tract infections (UTIs) occur commonly in children and may lead to substantial morbidity. Most experts recommend urine cultures for diagnosing UTIs in children. In addition, most experts recommend imaging studies in a portion of children diagnosed with UTIs.
Purpose:
The purpose of this study was to assess how rates of performance of urine cultures and imaging studies for children in the Alabama Medicaid program diagnosed with a UTI vary by patient demographics, provider characteristics, and service locations.
Methods:
The study design was a retrospective review of Alabama Medicaid claims data. Children were included as UTI cases if they had a Medicaid claim for urinary tract infections during 1991, were continuously enrolled in Medicaid for that year, and were younger than 8 years of age. Claims were grouped into episodes of care, and episodes were assigned to a diagnosing physician. Physician locations were classified as rural, suburban, or urban using demographic data. Specific laboratory and imaging procedures were identified using CPT codes (Physician's Current Procedural Technology Codes, 4th Edition).
Results:
We identified 404 episodes of UTI occurring in 380 children. Only 47% of episodes were associated with claims for urine cultures. Claims for urine cultures were more frequently filed by pediatricians in urban locations. In the subset of 114 patients with multiple UTI episodes, only 68% had imaging studies specific for the urinary tract. Only 44% received both a voiding cystourethrogram and renal ultrasound.
Conclusions:
Claims data suggest that physicians underuse urine cultures in diagnosing UTIs in Alabama pediatric Medicaid recipients. Urban-based pediatricians perform better than other types of physicians. Imaging studies are also used less frequently than is commonly recommended.