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Health Care Utilization for Children in Foster Care

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OBJECTIVE: To utilize hospital EMR data for children placed in foster care (FC) and a matched control group to compare: 1) healthcare utilization rates for primary care, subspecialty care, emergency department (ED) visits, and hospitalizations; 2) overall charges per patient-year; and, 3) prevalence of complex chronic conditions (CCC) and their effect on utilization. METHODS: Children ≤18 years old with a designation of FC placement and controls matched on age, race/ethnicity, gender, and zip code who had an encounter at an urban pediatric health system between 7/1/11-6/30/12 were identified in the EMR. Data on outpatient, ED, and inpatient encounters and charges for 7/1/12-6/30/13 were obtained. A general linear mixed effects model was applied to estimate means and rates for each group. Analyses were repeated among the subpopulations of children with and without CCCs. RESULTS: 1,156 FC cases were matched to 4,062 controls (mean=3.5 controls/case). FC cases had significantly higher rates (per 100 patient-years) of hospitalizations (18.5 vs. 12.7, p=0.005), and subspecialty visits (173.3 vs. 113.6; p<0.001) but not ED (50.4 vs. 45.2, p=0.056) or primary care visits (154.6 v. 149.8; p=0.50). FC cases had higher charges ($14,372 vs. $7,082; p<0.001). Among children with CCCs, healthcare utilization rates and charges were higher among FC cases (all p<0.001). Among children without CCC, rates and charges were similar for FC cases and controls (all p>0.2). CONCLUSIONS: FC children utilized more hospitalizations and subspecialty office visits. The increased utilization rates and charges among children in FC were driven by the subset of children with CCCs.


Bennett CE, Wood JN, Scribano PV