The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #63598

Troy A. Jacobs, MD, MPH¹, Elinor A Graham, MD, MPH¹, Jane Cover, MPH², and Tao S. Kwan-Gett, MD, MPH¹. (1) Department of Pediatrics, Harborview Medical Center, University of Washington, MS 359774, 325 9th Ave, Seattle, WA 98104, 206-341-4600, tjacobs@u.washington.edu, (2) Sociology, University of Washington, 2002 Savery, Box 353340, Seattle, WA 98195

In this study a sample of 2074 English-proficient (EP) children and 1041 limited English proficient (LEP) children are compared by insurance enrollment & health care utilization. LEP children are further compared by use of a care coordination (CC) program (available to 415 LEP children). A database was constructed from Medicaid managed care enrollment files, clinical records, and interpreter services files for a two-year period for children under 19 yo. Data were analyzed with STATA 7.0-SE and were adjusted for clustered events & discontinuous enrollment. Mean Medicaid enrollment months were greater for LEP children (17.1 vs. 15.6) although CC showed no differences when compared to the non-CC group (17.0 vs. 17.3). LEP children made more visits on average & this was truer for CC children. LEP children made more visits (as defined as mean visits per member-month enrolled) to primary care sites than EP children (0.267 vs. 0.194); there was less utilization by LEP children of specialty care (0.122 vs. 0.094) and emergency sites (0.095 vs. 0.101). When compared to non-CC children, greater utilization of primary care occurred for CC children (0.318 vs. 0.204) but increased utilization also occurred with specialty (0.127 vs. 0.113) and emergency care (0.097 vs. 0.092). In general, LEP children made more preventative visits than EP children (0.134 vs. 0.121) and a similar pattern was seen for CC children (0.142 vs. 0.124). The relationships with other acute & chronic illness categories are more complex but show greater overall utilization by CC children.

Learning Objectives:

• Describe differences in Medicaid enrollment and health care utilization in limited English proficient (LEP) children when compared to English proficient (EP) children.
• Describe the impact of a care coordination program for LEP children on enrollment & health utilization.
• Identify a method for analyzing health services data when data is recurrent, correlated, and discontinous.

Keywords: Immigrants, Health Care Utilization

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: University of Washington; Robert Wood Johnson Foundation