Specialist use among privately insured children with disabilities

Abstract

Objective: To investigate primary care practice ownership and specialist-use patterns for commercially insured children with disabilities.

Data sources and study setting: A national commercial claims database and the Health Systems and Provider Database from 2012 to 2016 are the data sources for this study.

Study design: This cross-sectional, descriptive study examines: (1) the most visited type of pediatric primary care physician and practice (independent or system-owned); (2) pediatric and non-pediatric specialist-use patterns; and (3) how practice ownership relates to specialist-use patterns.

Data collection/extraction methods: This study identifies 133,749 person-years of commercially insured children with disabilities aged 0-18 years with at least 24 months of continuous insurance coverage by linking a national commercial claims data set with the Health Systems and Provider Database and applying the validated Children with Disabilities Algorithm.

Principal findings: Three-quarters (75.9%) of children with disabilities received their pediatric primary care in independent practices. Nearly two thirds (59.6%) used at least one specialist with 45.1% using nonpediatric specialists, 28.8% using pediatric ones, and 17.0% using both. Specialist-use patterns varied by both child age and specialist type. Children with disabilities in independent practices were as likely to see a specialist as those in system-owned ones: 57.1% (95% confidence interval [95% CI] 56.7%-57.4%) versus 57.3% (95% CI 56.6%-58.0%), respectively (p = 0.635). The percent using two or more types of specialists was 46.1% (95% CI 45.4%-46.7%) in independent practices, comparable to that in systems 47.1% (95% CI 46.2%-48.0%) (p = 0.054). However, the mean number of specialist visits was significantly lower in independent practices than in systems-4.0 (95% CI 3.9%-4.0%) versus 4.4 (95% CI 4.3%-4.6%) respectively-reaching statistical significance with p < 0.0001.

Conclusions: Recognizing how privately insured children with disabilities use pediatric primary care from pediatric and nonpediatric primary care specialists through both independent and system-owned practices is important for improving care quality and value.

Keywords: disability; health care organizations and systems; primary care.

FIGURE 1

Mean number of specialist visits to selected specialists among commercially insured children with disabilities, aged 0–18.^a Thin dashed line corresponds to pediatric specialists, thick solid line corresponds to nonpediatric specialists. Y‐axis scale varies between panels to facilitate viewing patterns by age. ^aList of nonpictured specialists available in Supplement. ^bAmong those with any specialist use. ^cPediatric psychiatry appears twice, with other developmental specialists and with nonpediatric psychiatry. ^dGray line indicates 0 visits at all ages (pediatric physical medicine and rehabilitation).