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Abstract #148344

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José Capriles, MD, MPH, MHSA, Ruth Ríos, PhD, Mario H. Rodríguez, PhD, and Yelitza Sánchez, MS. Puerto Rico Health Services Research Institute, University of Puerto Rico, Graduate School of Public Health, P O BOX 365067, San Juan, PR 00936-5067, 787-758-2525 ext. 1403, jcapriles@rcm.upr.edu

Statement of the problem: Most asthma hospitalizations for children are preventable with adequate disease management described in National Educational Prevention Program (NAEPP). Nevertheless, disparities are observed in health services utilization in Puerto Rican children by insurance coverage.

Objective: To compare outpatient health services utilization patterns by health insurance coverage among children with asthma who at least one hospitalization per year.

Methods: This study explores the patterns of outpatient health care utilization for children under 18 years old diagnosed with asthma reporting at least one hospital admission per year in a group of beneficiaries of the Puerto Rico Health Care Reform (MC, managed care) and those with private insurance (FFS, fee-for-service). A total of 3,250 insurance claims for three years were analyzed.

Results: The FFS enrollees correspond to a higher mean of physician office visits (11 vs. 1), emergency department (ED) visits (3 vs. 1), and number of drug prescriptions (19 vs. 3) than MC group. These trends hold true in the logistic regression analysis where the FFS group show a higher probability of outpatient services use than the MC group with the exception of ED visits. The MC group has a higher probability to visit the ED than the FFS group (OR= 1.5; 95% CI= 1.36-1.60).

Conclusions: These results illustrate differences in the way pediatric asthma patients are treated according to their insurance status. It is vital further research assessing how the system structure, policies of practice sites, adherence to NAEPP guidelines and quality of services impact asthma management.

Learning Objectives:

• Identify patterns of outpatient health services utilization in pediatric asthma patients with one hospital admission.
• Recognize the differences in the health services utilization in asthma patients considering their insurance status.

Keywords: Health Disparities, Health Care Utilization

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

• Slides (pdf) or Handout