Knight Erin K, McDuffie May Joan, Gifford Katie, Zorc Catherine
Del Med J. 2016 Feb;88(2):46-52.
Children in foster care represent some of the most vulnerable children in the U.S. Their higher prevalence of a range of physical and behavioral health problems can lead to greater health care utilization and higher costs. However, many children in foster care have undiagnosed conditions and unmet needs. The purpose of this study was to provide a description of health services accessed by children in foster care in Delaware. The data serves as a baseline and informs current efforts to improve the health care of children in foster care. We analyzed rates of emergency room visits, behavioral health visits, hospitalizations, and costs of care for children in foster care and made comparisons with other children participating in Medicaid. We also looked at utilization before and after entry into care and assessed rates of appropriate medical screening for children on entering foster care. This study was conducted as part of a larger analysis guided by the Delaware Task Force on the Health of Children in Foster Care with funding appropriated by the Delaware General Assembly.
Using a unique identification number, we linked Medicaid claims data with demographic information and characteristics associated with foster care from the Delaware Department of Services for Children, Youth and Their Families. We examined diagnoses, patterns of utilization, and costs for children in foster care (n = 1,458) and a comparable cohort of other children in Medicaid (n = 124,667) during fiscal years 2013 and 2014.
Compared with other children in Medicaid, children in foster care had similar rates of emergency department utilization, but relatively high rates of outpatient behavioral health visits. Similarly, compared with other children in Medicaid, those in foster care had particularly high rates of psychotropic drug utilization. Entry into foster care was associated with increased utilization of overall health care services, including receipt of well-child care. However, just 31 percent of those new to foster care met the recommended guidelines for a preventive screening in their first 30 days.
Because of the challenges in meeting screening policies for children entering foster care, collaboration among providers, state administrators, and policymakers is essential to guide improvement. Specifically, stakeholders should look for ways to improve the timeliness of preventive screenings and coordination of care. The high rate of behavioral health visits suggests the need to improve integration of behavioral health care into primary care.
寄养儿童是美国最脆弱的儿童群体之一。他们在一系列身体和行为健康问题上的较高患病率会导致更高的医疗保健利用率和成本。然而，许多寄养儿童存在未被诊断的病症和未满足的需求。本研究的目的是描述特拉华州寄养儿童所接受的健康服务。这些数据作为基线，并为当前改善寄养儿童医疗保健的努力提供信息。我们分析了寄养儿童的急诊就诊率、行为健康就诊率、住院率和护理成本，并与其他参加医疗补助计划的儿童进行了比较。我们还研究了进入寄养机构前后的利用率，并评估了寄养儿童进入时进行适当医疗筛查的比例。本研究是由特拉华州寄养儿童健康问题特别工作组指导的一项更大规模分析的一部分，资金由特拉华州议会拨款。
我们使用一个唯一识别号码，将医疗补助计划索赔数据与特拉华州儿童、青少年及其家庭服务部提供的与寄养相关的人口统计信息和特征相链接。我们研究了2013财年和2014财年寄养儿童（n = 1458）以及医疗补助计划中其他儿童的可比队列（n = 124667）的诊断、使用模式和成本。
与医疗补助计划中的其他儿童相比，寄养儿童的急诊利用率相似，但门诊行为健康就诊率相对较高。同样，与医疗补助计划中的其他儿童相比，寄养儿童的精神药物使用率特别高。进入寄养机构与整体医疗保健服务利用率的增加有关，包括接受儿童健康护理。然而，刚进入寄养机构的儿童中只有31%在最初30天内达到了预防性筛查的推荐指南。
由于在满足寄养儿童筛查政策方面存在挑战，提供者、州管理人员和政策制定者之间的合作对于指导改进至关重要。具体而言，利益相关者应寻找方法来提高预防性筛查的及时性和护理协调。行为健康就诊率高表明需要改善行为健康护理与初级护理的整合。
