The Impact of Health Status on Health Care Utilization of Children in Foster Care.
Journal
Journal of developmental and behavioral pediatrics : JDBP
ISSN: 1536-7312
Titre abrégé: J Dev Behav Pediatr
Pays: United States
ID NLM: 8006933
Informations de publication
Date de publication:
17 Jul 2024
17 Jul 2024
Historique:
received:
12
02
2024
accepted:
24
05
2024
medline:
18
7
2024
pubmed:
18
7
2024
entrez:
18
7
2024
Statut:
aheadofprint
Résumé
This study sought to understand the health status of children in foster care; the relationship between their health status and health care utilization; and demographic and placement factors associated with health care utilization. To estimate relationships between health status and health care utilization, this study used electronic health records from 4976 children in foster care seen at a children's hospital in the southwestern United States, 2017 to 2020. An algorithm classified patients' health status as nonchronic, noncomplex chronic, or complex chronic. Descriptive statistics were used to describe patients and utilization. The χ2, Kruskal-Wallis, and pairwise comparison post hoc tests were used to examine relationships between health status and health care utilization. Zero-inflated negative binomial (ZINB) regression further estimated relationships between health status and health care utilization while factoring in demographic and placement characteristics. Within the sample, 35.6% had complex chronic health status. Significant differences were found among health status groups in age, gender, ethnicity, and maltreatment exposure. Both nonparametric pairwise comparisons and the ZINB regression model showed that having complex chronic health was associated with higher utilization of all hospital resources: emergency, admission, primary and specialty care, and various therapies, relative to having noncomplex chronic and nonchronic health. A high percentage of children in foster care had complex chronic health, and these patients used significantly more resources. This study suggests that hospital-based health clinics focused on children in foster care and care coordination may be warranted.
Identifiants
pubmed: 39023862
doi: 10.1097/DBP.0000000000001302
pii: 00004703-990000000-00194
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no conflicts of interest to disclose.
Références
Administration for Children and Families. The AFCARS Report #29. US Department of Health and Human Services, Administration for Children and Families, Children’s Bureau; 2022. Available at: https://www.acf.hhs.gov/sites/default/files/documents/cb/afcars-report-29.pdf. Accessed May 4, 2022.
Rubin DM, Alessandrini EA, Feudtner C, et al. Placement stability and mental health costs for children in foster care. Pediatrics. 2004;113:1336–1341.
Rubin DM, Alessandrini EA, Feudtner C, et al. Placement changes and emergency department visits in the first year of foster care. Pediatrics. 2004;114:e354–e360.
Takayama JI, Bergman AB, Connell FA. Children in foster care in the state of Washington. Health care utilization and expenditures. JAMA. 1994;271:1850–1855.
Halfon N, Berkowitz G, Klee L. Children in foster care in California: an examination of Medicaid reimbursed health services utilization. Pediatrics. 1992;89:1230–1237.
Keefe RJ, Cummings ADL, Greeley CS, et al. Mental health and developmental disorder diagnoses of foster and nonfoster children enrolled in Medicaid. J Dev Behav Pediatr. 2022;43:e296–e303.
Reynoso M, McLeigh J, Malthaner LQ, et al. Description of audiologic, developmental, ophthalmologic, and neurologic diagnoses at a primary care clinic for children in foster care. J Dev Behav Pediatr. 2022;43:511–520.
Herd T, Palmer L, Font S. Prevalence of mental health diagnoses among early adolescents before and during foster care. J Dev Behav Pediatr. 2023;44:e269–e276.
Leslie LK, Hurlburt MS, James S, et al. Relationship between entry into child welfare and mental health service use. Psychiatr Serv (Washington, D.C.). 2005;56:981–987.
Bennett CE, Wood JN, Scribano PV. Health care utilization for children in foster care. Acad Pediatr. 2020;20:341–347.
Knight EK, McDuffie MJ, Gifford K, et al. Health service utilization of children in Delaware foster care, 2013-2014. Del Med J. 2016;88:46–52.
Greiner MV, Ross J, Brown CM, et al. Foster caregivers' perspectives on the medical challenges of children placed in their care: implications for pediatricians caring for children in foster care. Clin Pediatr (Phila). 2015;54:853–861.
Woods SB, Farineau HM, McWey LM. Physical health, mental health, and behaviour problems among early adolescents in foster care. Child Care Health Dev. 2013;39:220–227.
Simon TD, Cawthon ML, Stanford S, et al. Pediatric medical complexity algorithm: a new method to stratify children by medical complexity. Pediatrics. 2014;133:e1647–e1654.
The Annie E. Casey Foundation. Black Children Continue to Be Disproportionately Represented in Foster Care; 2020. Available at: https://www.aecf.org/blog/us-foster-care-population-by-race-and-ethnicity. Accessed October 30, 2023.
Kortenkamp K, Ehrle J. The well-being of children involved with the child welfare system: a national overview. New federalism: national survey of America's families, series B, No. B-43. Assessing the New Federalism: An Urban Institute Program to Assess Changing Social Policies. The Urban Institute; 2002. https://eric.ed.gov/?id=ED462504. Accessed October 25, 2023.
Turney K, Wildeman C. Mental and physical health of children in foster care. Pediatrics. 2016;138:e20161118.
Cohen E, Berry JG, Camacho X, et al. Patterns and costs of health care use of children with medical complexity. Pediatrics. 2012;130:e1463–e1470.
Silber JH, Rosenbaum PR, Pimentel SD, et al. Comparing resource use in medical admissions of children with complex chronic conditions. Med Care. 2019;57:615–624.
Kuo DZ, Melguizo-Castro M, Goudie A, et al. Variation in child health care utilization by medical complexity. Matern Child Health J. 2015;19:40–48.
Jee SH, Antonucci TC, Aida M, et al. Emergency department utilization by children in foster care. Ambul Pediatr. 2005;5:102–106.
Jackson Y, Cushing CC, Gabrielli J, et al. Child maltreatment, trauma, and physical health outcomes: the role of abuse type and placement moves on health conditions and service use for youth in foster care. J Pediatr Psychol. 2016;41:28–36.
Bonomi AE, Anderson ML, Rivara FP, et al. Health care utilization and costs associated with childhood abuse. J Gen Intern Med. 2008;23:294–299.
Noll JG. Sexual abuse of children—unique in its effects on development? Child Abuse Negl. 2008;32:603–605.
Teicher MH, Samson JA, Polcari A, et al. Length of time between onset of childhood sexual abuse and emergence of depression in a young adult sample: a retrospective clinical report. J Clin Psychiatry. 2009;70:684–691.
Coller RJ, Nelson BB, Klitzner TS, et al. Strategies to reduce hospitalizations of children with medical complexity through complex care: expert perspectives. Acad Pediatr. 2017;17:381–388.
Jaudes KP, Champagne V, Harden A, et al. Expanded medical home model works for children in foster care. Child Welfare. 2012;91:9–33.
Cohen E, Friedman JN, Mahant S, et al. The impact of a complex care clinic in a children's hospital: complex care clinic. Child Care Health Dev. 2010;36:574–582.
American Academy of Pediatrics, ed. Fostering Health: Health Care for Children and Adolescents in Foster Care. 2nd ed. American Academy of Pediatrics; 2005.