Lewis Kanna N, McKelvey Lorraine M, Zhang Dong, Moix Elise, Whiteside-Mansell Leanne
University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA.
University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA.
Child Abuse Negl. 2023 Nov;145:106396. doi: 10.1016/j.chiabu.2023.106396. Epub 2023 Aug 11.
The American Academy of Pediatrics recommends all pediatricians to be ready to implement trauma-informed care, including the mitigation of impacts of Adverse Childhood Experiences (ACEs) through screening and identification of at-risk population. Reliable survey tools and knowledge of the consequences of ACEs are needed.
This study examines the healthcare utilization and diagnoses captured in insurance claims in association with the number of ACEs recorded by the Family Map Inventories (FMI). The FMI offers a comprehensive family assessment, which includes child ACEs (FMI-ACEs) using prospective, proxy risk indicators.
Low-income families (N = 1647) with children aged three to five years who completed the FMI were linked to their insurance records.
Multivariable logistic and generalized linear regression models were fitted to explore the association between the number of ACEs (FMI-ACEs scores) and healthcare utilization and health outcomes.
Children were exposed at rates of 32.4 % to zero, 31.7 % to one, 19.7 % to two, and 16.3 % to three or more ACEs. The FMI-ACEs scores were associated with greater use of non-preventive outpatient visits, filled prescriptions, and overall use of healthcare. Incidences of adjustment disorders were 4 times and attention-deficit conducts were 2 times higher among children with the highest FMI-ACEs scores than those with zero FMI-ACEs.
This study marks the first effort to conduct insurance claims data review to ascertain association between a survey measure of ACEs and health utilization and diagnosed conditions. The association of ACEs risk screening and healthcare utilization and diagnoses was observed.
美国儿科学会建议所有儿科医生准备好实施创伤知情护理，包括通过筛查和识别高危人群来减轻童年不良经历（ACEs）的影响。需要可靠的调查工具以及对ACEs后果的了解。
本研究调查了保险理赔中记录的医疗保健利用情况和诊断结果，并将其与家庭地图清单（FMI）记录的ACEs数量相关联。FMI提供了全面的家庭评估，其中包括使用前瞻性代理风险指标的儿童ACEs（FMI-ACEs）。
完成FMI的三至五岁儿童的低收入家庭（N = 1647）与他们的保险记录相关联。
采用多变量逻辑回归和广义线性回归模型，探讨ACEs数量（FMI-ACEs评分）与医疗保健利用和健康结果之间的关联。
儿童暴露于ACEs的比例分别为：32.4%为零次，31.7%为一次，19.7%为两次，16.3%为三次或更多次。FMI-ACEs评分与更多地使用非预防性门诊就诊、开具的处方以及整体医疗保健利用相关。FMI-ACEs评分最高的儿童中，适应障碍的发生率是FMI-ACEs评分为零的儿童的4倍，注意力缺陷行为的发生率是其2倍。
本研究首次对保险理赔数据进行审查，以确定ACEs的一项调查指标与医疗保健利用及诊断状况之间的关联。观察到了ACEs风险筛查与医疗保健利用及诊断之间的关联。
