Child Health Evaluation and Research Unit, Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan 48109-5456, USA.
Pediatrics. 2010 Jan;125(1):43-9. doi: 10.1542/peds.2009-1044. Epub 2009 Nov 30.
To examine the degree to which current health care utilization patterns of Medicaid-enrolled adolescents living in Michigan would allow opportunities for adolescent immunizations to be provided.
Outpatient claims data from 2001-2005 were analyzed for 11- to 18-year-old Medicaid-enrolled adolescents living in Michigan. Visits were classified as either health-maintenance examinations (HMEs) or problem focused by using diagnostic and procedural codes. Data were divided into 4 overlapping 2-year time periods, and the age-specific proportion of adolescents who attended these 2 visit types was calculated for each. chi(2) tests were used to evaluate associations of visit patterns with gender.
Of the 718847 adolescents included in the study, <50% had >or=1 HME visit within any 2-year time period, and substantially fewer (<15%) had annual HMEs. In contrast, at least 75% of the adolescents had >or=1 problem-focused visit in any given 2-year period, and approximately half had participated in at least 2 problem-focused visits. Problem-focused, but not HME, visit utilization was significantly associated with gender, with girls increasing, but boys decreasing, visit utilization as they aged.
Similar to privately insured adolescents, most Medicaid-enrolled adolescents do not have annual preventive-care visits, which calls into question the feasibility of providing immunizations primarily at annual HMEs. Participation in problem-focused encounters was generally high in our study. However, even problem-focused visit utilization was low among older adolescent boys. This suggests that in addition to strengthening immunization within the medical home, alternative venues for reaching certain subpopulations of adolescents should also be developed.
研究密歇根州参加医疗补助计划的青少年目前的医疗保健利用模式，以确定是否有机会提供青少年免疫接种。
分析了 2001 年至 2005 年期间密歇根州参加医疗补助计划的 11 至 18 岁青少年的门诊理赔数据。通过诊断和程序代码将就诊分为健康维护检查（HME）或问题导向。将数据分为 4 个重叠的 2 年时间段，并计算每个时间段内参加这 2 种就诊类型的青少年的年龄特异性比例。使用卡方检验评估就诊模式与性别之间的关联。
在研究的 718847 名青少年中，<50%的人在任何 2 年时间内有>或=1 次 HME 就诊，而很少(<15%)的人每年进行 HME。相比之下，至少 75%的青少年在任何给定的 2 年期间有>或=1 次问题导向就诊，约一半的青少年至少进行了 2 次问题导向就诊。问题导向就诊，而不是 HME，就诊利用与性别显著相关，随着年龄的增长，女孩就诊利用增加，而男孩就诊利用减少。
与私人保险的青少年相似，大多数参加医疗补助计划的青少年没有年度预防保健就诊，这使得主要通过年度 HME 提供免疫接种的可行性受到质疑。在我们的研究中，问题导向就诊的参与率通常较高。然而，即使是问题导向就诊的利用率在年龄较大的青少年男孩中也较低。这表明，除了在医疗保健家庭中加强免疫接种外，还应开发其他途径来接触某些青少年亚群。
