Ninth Annual Maternal and Child Health Epidemiology Conference

1
Ninth Annual Maternal and Child Health
Epidemiology Conference

• 10 December 2003
• Tempe, Arizona

2
Emergency Departments as a Source of Care for
Latino Children in a Border Community

• William G. Johnson, Ph.D.
• Arizona State University
• 480-965-7442
• William.g.johnson_at_ asu.edu
• Mary E. Rimsza, M.D.
• Arizona State University
• 480-965-1622
• Mary.Rimsza_at_asu.edu

3
The Community Health Data System (CHDS) Model

• Obtain routinely collected administrative data
  from employers, insurers, providers and health
  related organizations
• Merge across data sources to create integrated
  individual records for each person
• Encrypt identifiers

4
The Yuma County CHDSFlinn/ASU

• Insurance status, health care utilization and
  demographic characteristics of more than 60,000
  children
• 1999-2002 and continuing
• Sponsors The Flinn Foundation/ASU

5
Advantages

• Information is available when questions arise
  rather than a collect it when the question is
  asked approach
• Data available without long time lags
• More cost effective than project by project data
  collection
• Capture changes over time

6
Insurance Coverage Varies by Race/Ethnicity, 2001
7
Health Care Utilization 2001
8
Children See Multiple Providers2001
Outpatient
Other Providers N5,860
N16,116
N4,606
N3,388
ER
N1,588
N3,384
N124
N998
Inpatient
9
A Majority of ED Users Are Insured
10
ED Utilization by Ethnicity Insured
11
ED Utilization by Ethnicity Uninsured
12
ED Utilization for Non-Urgent Care
1999Multivariate Models

13
Characteristics That Affect Access to Health Care
14
Multivariate Results ED for Non-Urgent Care
(Pediatrics)

• Uninsured 4X Likely to use ED
• Access to pediatric care 73 less likely to use
  ED if insured 93 if uninsured
• Adolescents most likely age group to use ED
• Controlling for insurance coverage, Latino
  children no more likely to use ED

15
Multivariate Results ED Sole Source for
Non-Urgent Care

• Uninsured 7X More Likely to use ED as sole source
• Native American children most likely ethnic group
  to rely on ED
• Latino children 70 less likely to rely on ED if
  uninsured
• Latino children not different from White
  Non-Latino if insured

16
Tracking Children Over Time1999-2001

17
Health Care Utilization1999-2001
1999 2000 2001 No. of Children
X X X 13,596 24.6
X 12,442 22.5
X 7,802 14.1
X X 7,331 13.3
X 6,233 11.3
X X 5,100 9.2
X X 2,695 4.9
29,193 32,260 36,064 55,199 100
18
Insurance Patterns for Latino Children, 1999-2001
Two years interrupted 1.9
One year interrupted 8.3
Three years interrupted 0.4
Interrupted periods 10.6
Continuous Uninsured 0.3
Continuously Insured 89.20
19
Specific Conditions by Ethnicity, 1999 - 2001
Cohort
percent
20
Specific Conditions by Ethnicity, 1999 - 2001
Cohort (cont.)
percent
21
Research in Progress

22
Ongoing Research from the Yuma CHDS Data

• Air Pollution and the Incidence of Respiratory
  Conditions
• The Prevalence and Treatment of Asthma by
  Ethnicity
• Patterns of Health Insurance Coverage over Time
  by Ethnicity
• The Effects of Changing Insurance Coverage on
  Access to Care

23
Next Steps M-HIP Project St. Lukes/ASU

• M-HIP Maricopa Health Information Project
• All residents of Maricopa County
• Operational as of July 1, 2003
• Sponsor St. Lukes Health Initiatives
• Endorsed by Arizona Medical Association

24
Additional Information

• William G. Johnson
• Professor of Economics
• School of Health Administration Policy
• W. P. Carey School of Business
• Arizona State University
• William.g.johnson_at_asu.edu
• 602-840-4293
• 480-965-7442