Bohnhoff James, Bodnar Chelsea, Graham Jon, Knudson Jonathon, Fox Erika, Leary Cindy, Cater Lauren, Noonan Curtis
Department of Pediatrics (J Bohnhoff), MaineHealth, Portland, Maine; Center for Interdisciplinary Population & Health Research (J Bohnhoff), MaineHealth Institute for Research, Westbrook, Maine.
Montana Pediatrics (C Bodnar), Kalispell, Mont.
Acad Pediatr. 2025 May-Jun;25(4):102628. doi: 10.1016/j.acap.2024.102628. Epub 2024 Dec 24.
To describe children with medical complexity (CMC) in Montana according to their clinical characteristics, rurality, and distance from specialty care, and to assess for disparities in geographic access to specialty care for American Indian children.
In this cross-sectional study, we categorized children in 2016-21 Montana Medicaid claims data using the Pediatric Medical Complexity Algorithm and compared the associations of medical complexity and demographic traits using chi-square tests. Using a database of providers, we calculated drive times from children's residences to the nearest pediatric subspecialist and calculated bootstrap confidence intervals for the difference in median driving distances by complexity and race.
Among 126,873 children, 23% lived in rural areas and 20% were reported as American Indian. In all, 10,766 children (8.5%) had complex chronic conditions (children with medical complexity, CMC), and 27,431 (21.6%) had noncomplex chronic conditions. Medical complexity was associated with age, race, ethnicity, sex, Children's Health Insurance Program enrollment, disability, and rurality. CMC had shorter median drive times to care than children with noncomplex medical conditions and children without chronic conditions (28 vs 34 and 43 minutes, 95% confidence intervals of differences 4-9 and 6-11). At each level of medical complexity, the median distance from care was greater for American Indian children than children of other races.
Although CMC tend to live closer to specialists than other children, many CMC live far from subspecialty care. American Indian children live farther from specialists than other children, regardless of complexity. Future work should support access to care for rural and American Indian CMC.
根据蒙大拿州患有复杂疾病的儿童（CMC）的临床特征、农村地区情况以及与专科护理的距离进行描述，并评估美国印第安儿童在获得专科护理的地理可及性方面的差异。
在这项横断面研究中，我们使用儿科疾病复杂程度算法对2016 - 2021年蒙大拿州医疗补助索赔数据中的儿童进行分类，并使用卡方检验比较疾病复杂程度与人口统计学特征之间的关联。利用提供者数据库，我们计算了从儿童住所到最近的儿科专科医生的驾车时间，并计算了按疾病复杂程度和种族划分的中位驾车距离差异的自助置信区间。
在126,873名儿童中，23%生活在农村地区，20%被报告为美国印第安人。总共有10,766名儿童（8.5%）患有复杂慢性病（患有复杂疾病的儿童，CMC），27,431名（21.6%）患有非复杂慢性病。疾病复杂程度与年龄、种族、民族、性别、儿童健康保险计划参保情况、残疾状况和农村地区情况相关。与患有非复杂疾病的儿童和无慢性病的儿童相比，CMC前往就医的中位驾车时间更短（分别为28分钟、34分钟和43分钟，差异的95%置信区间为4 - 9分钟和6 - 11分钟）。在每个疾病复杂程度水平上，美国印第安儿童到专科护理的中位距离都比其他种族的儿童更远。
尽管CMC往往比其他儿童住得离专科医生更近，但许多CMC住得离专科护理很远。无论疾病复杂程度如何，美国印第安儿童住得比其他儿童离专科医生更远。未来的工作应支持农村和美国印第安CMC获得医疗服务。
