Receipt of asthma subspecialty care by children in a managed care organization

Michael Cabana, David Bruckman, Jerry L. Rushton, Susan L. Bratton, Lee Green

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background. - Although proper outpatient asthma management sometimes requires care from subspecialists, there is little information on factors affecting receipt of subspecialty care in a managed care setting. Objective. - To determine factors associated with receipt of subspecialty care for children with asthma in a managed care organization. Methods. - We conducted an analysis of the claims from 3163 children with asthma enrolled in a university-based managed care organization from January 1998 to October 2000. We used logistic regression analysis to determine factors associated with an outpatient asthma visit with an allergist or pulmonologist. Results. - Of the 3163 patients, 443 (14%) had at least 1 subspecialist visit for asthma; 354 (80%) were seen by an allergist, 63 (14%) were seen by a pulmonologist, and 26 (6%) were seen by both. In multivariate analysis, patients with more severe asthma (odds ratio [OR], 3.81; 95% confidence interval [CI], 2.99-4.86) and older patients (OR, 1.04; 95% CI, 1.02-1.07) were more likely to receive care from a subspecialist. Compared with Medicaid patients, both non-Medicaid patients with copayment (OR, 2.52; 95% CI, 1.85-4.43) and non-Medicaid patients without any copayment (OR, 3.40; 95% CI, 2.35-4.93) were more likely to receive care from an asthma subspecialist. Conclusions. - Children insured by Medicaid are less likely to receive care from subspecialists for asthma. Reasons may be due to health care system-related factors, such as accessibility of subspecialists, to physician referral decisions, and/or to patient factors, such as adherence to recommendations to see a subspecialist. Our findings suggest a need to further investigate health care system barriers, physician.

Original languageEnglish (US)
Pages (from-to)456-461
Number of pages6
JournalAmbulatory Pediatrics
Volume2
Issue number6
DOIs
StatePublished - Jan 1 2002
Externally publishedYes

Fingerprint

Managed Care Programs
Child Care
Asthma
Organizations
Odds Ratio
Confidence Intervals
Medicaid
Outpatients
Insurance Claim Review
Delivery of Health Care
Physicians
Referral and Consultation
Multivariate Analysis
Logistic Models
Regression Analysis

Keywords

  • Asthma
  • Managed care
  • Medicaid
  • Pediatrics
  • Subspecialty care

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Receipt of asthma subspecialty care by children in a managed care organization. / Cabana, Michael; Bruckman, David; Rushton, Jerry L.; Bratton, Susan L.; Green, Lee.

In: Ambulatory Pediatrics, Vol. 2, No. 6, 01.01.2002, p. 456-461.

Research output: Contribution to journalArticle

Cabana, Michael ; Bruckman, David ; Rushton, Jerry L. ; Bratton, Susan L. ; Green, Lee. / Receipt of asthma subspecialty care by children in a managed care organization. In: Ambulatory Pediatrics. 2002 ; Vol. 2, No. 6. pp. 456-461.
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