Retrospective cohort study of children with and without CCC. Children 1≤17 years were identified in Truven Market Scan® Medicaid claims database of 10 anonymous states for years 2009-2011. Children categorized as having 0,1,2,or ≥3 CCCs using the revised Feudtner ICD-9 methodology. These CCCs are severe diagnoses; chronic constipation is not a CCC in this methodology. Outcomes Diagnosis of constipation: ICD-9 of constipation 564.0, intestinal impaction 560.3, encopresis 307.7 Outpatient treatment: diagnosis (above) and prescription within 2 days Inpatient treatment: diagnosis of constipation above, or as a secondary diagnosis with a non- specific abdominal first dia Costs were based on Medicaid claims and payments. Descriptive, bivariate, and multivariate analysis used to evaluate utilization by CCC class. Background Constipation Diagnosis and Related Health Services in Medicaid for Children With and Without Complex Chronic Conditions Children with CCCs have increased risk for constipation. Since this increases utilization and spending, including inpatient admission, proactively addressing constipation for children with CCC may improve care and decrease utilization. Diagnosis of constipation in children is common, and increases with presence of CCCs. Spending for constipation disproportionately occurs in children with CCCs. Inpatient constipation treatment is rare occurring in less than 0.5% of children with the diagnosis. Odds of inpatient treatment is 100 times greater in children with 3 or more CCCs. Michael J. Steiner 1 , John R. Stephens 1 , Neal A. DeJong 1 , Jonathan Rodean 2 , Troy Richardson 2 , Matt Hall 2 , Jay G. Berry 3 1 University of North Carolina & North Carolina Children’s Hospital, 2 Children’s Hospital Association, 3 Harvard University & Children’s Hospital Boston Costs The $79 million spent on constipation over 3 years was 0.4% of total Medicaid inpatient and outpatient spending in those states. Outpatient cost per case was $120 ED cost per case was $248 Inpatient cost per case was $7,815 Children with CCCs account for 34% of the spending while representing only 7% of the population. Prescriptions Only 4.8% of diagnosed cases had a laxative prescribed and filled. Docusate sodium was the most commonly prescribed laxative in this cohort. Results Methods Conclusions Implications Acknowledgments Constipation is a common health concern in children. Children with complex chronic conditions (CCC) may be at particular risk for constipation due to the potential for impaired gastrointestinal function, medication side effects, and limited mobility. Objective To compare the utilization of health services for constipation by children with CCC compared to other children Limitations Only able to track utilization while on Mediciad Study dependent on ICD-9 coding Many laxatives are available without a prescription, and these can not be identified through Medicaid. 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% CCC yes CCC no Outpatient Pharmacy ED Inpatient $26,600,062 $52,852,413 Figure. Allocation of Constipation-related Spending By CCC Total Cohort Diagnosis Outpatient Treatment ED Treatment Inpatient (%) Patients N=4,929,967 5.4 0.3 0.1 n=1363 Age Groups 1 to 2 yr 24.1 5.9 0.2 n=516 n=188 3 to 5 yr 18.7 6.5 0.3 n=438 n=276 6 to 12 yr 35.9 5.7 0.3 n=861 n=614 13 to 17 yr 21.3 3.5 0.3 0.1 n=285 Sex Female 48.9 6.0 0.3 0.1 n=616 Male 51.1 4.8 0.2 0.1 n=747 Race/ Ethnicity Black 28.8 5.4 0.2 0.1 n=318 White 46.4 5.8 0.3 0.1 n=698 Hispanic 10.4 5.0 0.2 n=136 n=88 Other 14.3 4.7 0.2 0.1 n=259 CCCs 0 93.2 4.9 0.2 n=2008 n=609 1 5.5 11.0 0.6 0.1 0.1 >2 1.4 20.4 1.2 0.2 0.7 Table. Demographics for Sample and Those with Constipation (% with condition or if <0.1% then n reported) 0 5 10 15 20 25 30 35 40 45 50 Diagnosis Outpatient Treatment ED Treatment Inpatient 0 1 2 ≥3 Number of CCCS OR 97 Figure. Odds of Utilization by Number of CCCs
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Retrospective cohort study of children with and without CCC.
Children 1≤17 years were identified in Truven Market Scan® Medicaid claims database of 10 anonymous states for years 2009-2011.
Children categorized as having 0,1,2,or ≥3 CCCs using the revised Feudtner ICD-9 methodology.
These CCCs are severe diagnoses; chronic constipation is not a CCC in this methodology.
Outcomes
Diagnosis of constipation: ICD-9 of constipation 564.0, intestinal impaction 560.3, encopresis 307.7
Outpatient treatment: diagnosis (above) and prescription within 2 days
Inpatient treatment: diagnosis of constipation above, or as a secondary diagnosis with a non-specific abdominal first dia
Costs were based on Medicaid claims and payments.
Descriptive, bivariate, and multivariate analysis used to evaluate utilization by CCC class.
Background
Constipation Diagnosis and Related Health Services in Medicaid for Children With and Without Complex Chronic Conditions
Children with CCCs have increased risk for constipation.
Since this increases utilization and spending, including inpatient admission, proactively addressing constipation for children with CCC may improve care and decrease utilization.
Diagnosis of constipation in children is common, and increases with presence of CCCs.
Spending for constipation disproportionately occurs in children with CCCs.
Inpatient constipation treatment is rare occurring in less than 0.5% of children with the diagnosis.
Odds of inpatient treatment is 100 times greater in children with 3 or more CCCs.
Michael J. Steiner1, John R. Stephens1, Neal A. DeJong1, Jonathan Rodean2, Troy Richardson2, Matt Hall2, Jay G. Berry3 1University of North Carolina & North Carolina Children’s Hospital, 2Children’s Hospital Association, 3Harvard University & Children’s Hospital Boston
Costs
The $79 million spent on constipation over 3 years was 0.4% of total Medicaid inpatient and outpatient spending in those states.
Outpatient cost per case was $120
ED cost per case was $248
Inpatient cost per case was $7,815
Children with CCCs account for 34% of the spending while representing only 7% of the population.
Prescriptions
Only 4.8% of diagnosed cases had a laxative prescribed and filled.
Docusate sodium was the most commonly prescribed laxative in this cohort.
Results
Methods
Conclusions
Implications
Acknowledgments
Constipation is a common health concern in children.
Children with complex chronic conditions (CCC) may be at particular risk for constipation due to the potential for impaired gastrointestinal function, medication side effects, and limited mobility.
Objective
To compare the utilization of health services for constipation by children with CCC compared to other children Limitations
Only able to track utilization while on Mediciad
Study dependent on ICD-9 coding
Many laxatives are available without a prescription, and these can not be identified through Medicaid.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
CCC yes CCC no
Outpatient Pharmacy ED Inpatient
$26,600,062 $52,852,413
Figure. Allocation of Constipation-related Spending By CCC
Total Cohort Diagnosis Outpatient
Treatment ED Treatment Inpatient (%)
Patients N=4,929,967 5.4 0.3 0.1 n=1363
Age Groups
1 to 2 yr 24.1 5.9 0.2 n=516 n=188
3 to 5 yr 18.7 6.5 0.3 n=438 n=276
6 to 12 yr 35.9 5.7 0.3 n=861 n=614
13 to 17 yr 21.3 3.5 0.3 0.1 n=285
Sex
Female 48.9 6.0 0.3 0.1 n=616
Male 51.1 4.8 0.2 0.1 n=747
Race/
Ethnicity
Black 28.8 5.4 0.2 0.1 n=318
White 46.4 5.8 0.3 0.1 n=698
Hispanic 10.4 5.0 0.2 n=136 n=88
Other 14.3 4.7 0.2 0.1 n=259
CCCs
0 93.2 4.9 0.2 n=2008 n=609
1 5.5 11.0 0.6 0.1 0.1
>2 1.4 20.4 1.2 0.2 0.7
Table. Demographics for Sample and Those with Constipation
(% with condition or if <0.1% then n reported)
0
5
10
15
20
25
30
35
40
45
50
Diagnosis OutpatientTreatment
ED Treatment Inpatient
0 1 2 ≥3 Number of CCCS OR
97
Figure. Odds of Utilization by Number of CCCs
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