Health Care Utilization for Children in Foster Care

OBJECTIVE:To utilize hospital EMR data for children placed in foster care (FC) and a matched control group to compare: 1) health care utilization rates for primary care, subspecialty care, emergency department (ED) visits, and hospitalizations; 2) overall charges per patient-year; and 3) prevalence of complex chronic conditions (CCC) and their effect on utilization. METHODS:Children ≤18 years old with a designation of FC placement and controls matched on age, race/ethnicity, gender, and zip code who had an encounter at an urban pediatric health system between 7/1/11 and 6/30/12 were identified in the EMR. Data on outpatient, ED, and inpatient encounters and charges for 7/1/12 to 6/30/13 were obtained. A general linear mixed-effects model was applied to estimate means and rates for each group. Analyses were repeated among the subpopulations of children with and without CCCs. RESULTS:A total of 1156 FC cases were matched to 4062 controls (mean = 3.5 controls/case). FC cases had significantly higher rates (per 100 patient-years) of hospitalizations (18.5 vs 12.7, P = .005), and subspecialty visits (173.3 vs 113.6; P < .001) but not ED (50.4 vs 45.2, P = .056) or primary care visits (154.6 vs 149.8; P = .50). FC cases had higher charges ($14,372 vs $7082; P < .001). Among children with CCCs, health care utilization rates and charges were higher among FC cases (all P < .001). Among children without CCC, rates and charges were similar for FC cases and controls (all P > .20). CONCLUSIONS:FC children utilized more hospitalizations and subspecialty office visits. The increased utilization rates and charges among children in FC were driven by the subset of children with CCCs.