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@ asu.edu Mary E. Rimsza, M.D. Arizona State University 480-965-1622 Mary.Rimsza@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 N=5,860 N=16,116 N=4,606 N=3,388 N=1,588 ER N=3,384 N=124 N=998 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. Individual Characteristics Enabling Characteristics Need for Health Care Variables included in the model Age Sex Race and ethnicity Health insurance Place of residence Chronic medical conditions Variables not included in the model Duration of residence Health care beliefs Health care knowledge Education Occupation Convenience of regular source of care Past medical illness Severity of illness Disabilities 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

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. Luke’s/ASU • M-HIP = Maricopa Health Information Project • All residents of Maricopa County • Operational as of July 1, 2003 • Sponsor: St. Luke’s 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@asu.edu 602-840-4293 480-965-7442