Ninth Annual Maternal and Child Health Epidemiology Conference

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Ninth Annual Maternal and Child Health
Epidemiology Conference

• 10 December 2003
• Tempe, Arizona

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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

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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

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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

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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

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

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Characteristics That Affect Access to Health Care
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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

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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

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Tracking Children Over Time1999-2001

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Health Care Utilization1999-2001
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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
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Specific Conditions by Ethnicity, 1999 - 2001
Cohort
percent
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Specific Conditions by Ethnicity, 1999 - 2001
Cohort (cont.)
percent
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Research in Progress

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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

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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

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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