Ohio Department of Health

About: Ohio Department of Health is a government organization based out in Columbus, Ohio, United States. It is known for research contribution in the topics: Population & Public health. The organization has 308 authors who have published 354 publications receiving 14493 citations.

Health Care Utilization by Children With Chronic Illnesses: A Comparison of Medicaid and Employer-insured Managed Care

Abstract: Objectives. This study compared utilization of health care services by children with chronic conditions who were insured by either Medicaid or an employer group in 1992 and 1993. Five chronic conditions were selected to illustrate patterns of service use: asthma, attention deficit disorder, diabetes, epilepsy, and sickle cell anemia. Methodology. Administrative databases were used to develop estimates of health services utilization for children t tests were used to compare service use rates between Medicaid and employer-insured populations. Results. A total of 8668 children across all health plan groups had at least one of the selected conditions. Because Medicaid enrolled-children tended to be younger, analyses were adjusted for age. In both systems, a greater percentage of Medicaid children had these five study conditions (5%) compared with employer-insured children (3%), suggesting that the Medicaid population was sicker. Mean length of enrollment during the 2-year study was longer for children in employer-insured programs. Children with chronic conditions enrolled in Medicaid managed care generally used services at a higher rate compared with children with similar conditions enrolled in employer-insured managed care. The extent of the increased use varied by condition, by service type, and by plan. Children with any of the chronic conditions studied had from 2 to almost 5 times more ED visits if they were enrolled in Medicaid than if they were enrolled in employer-based managed care, depending on the specific condition. In one of the two plans, Medicaid-enrolled children had more outpatient services, laboratory services, and radiography services than their counterparts in employer-based managed care. The same pattern of use was found for home health services (except for children with diabetes) and for office visits (except for children with sickle cell). The results show higher use of all services by children with asthma and diabetes in Medicaid managed care compared with employer-based managed care. In contrast, the pattern is mixed for children with epilepsy and sickle cell. The sample size of children with these conditions was smaller than with the three other conditions, which may account, in part, for a varied pattern of results. The pattern of use for attention deficit hyperactivity disorder (ADHD) was generally different from the other conditions. Children with ADHD in employer-based managed care had more hospital admissions, hospital days, and office visits than their counterparts in Medicaid managed care. In contrast, Medicaid-enrolled children with ADHD had more ED visits, laboratory services, outpatient hospital visits, and radiography services. Other than ED visits, the differences in service use between Medicaid and employer-insured children with ADHD were minimal. Of note, the pattern for ADHD is the same for most services for Plans A and B (excluding home health visits). This utilization pattern may reflect service use for comorbid conditions. Part of this difference may be explained by differences in Medicaid eligibility criteria used by the two plans. Medicaid eligibility regarding level of poverty was more stringent in Plan A than in Plan B. Plan A showed consistently high service utilization for Medicaid children compared with employer-insured children; Plan B showed less consistency. There are several patterns of utilization common to all disease and insurance groups. The majority of care seems to be delivered in physicians9 offices, rather than in other locations. When comparing the differences by disease categories, asthma shows more statistically significant differences in utilization between Medicaid and commercially-insured children than the other conditions. Asthma is the most prevalent condition of these five, which increases the power to detect statistical significance for this defined population. These results show the importance of evaluating conditions other than asthma, because utilization comparisons for different services may vary depending on the condition studied. Conclusion. This study of children with selected chronic health conditions indicates that: 1) a higher percentage of children enrolled in Medicaid managed care (5%) have these conditions compared with children enrolled in employer-insured managed care programs (3%); 2) on average, children with chronic health conditions who are enrolled in Medicaid managed care use more services than children with similar conditions who are insured through employers; and 3) although utilization rates are generally higher for children enrolled in Medicaid managed care than for children enrolled in employer-based managed care, the differences in rates vary greatly by service, by diagnosis, and by plan. Differences between the children enrolled in Medicaid and children enrolled in employer-based programs were more pronounced in one of the plans we studied compared with the other. Children with chronic conditions in Medicaid managed care have substantially different patterns of service use compared with children with similar conditions in employer-based managed care. This finding has major implications for policy development related to legislative proposals regarding referral practices, quality assurance, and capitation rates. Our results demonstrate the importance of examining a broad spectrum of chronic conditions and services when comparing Medicaid to employer-insured children with special needs. Utilization of several services, including ED, was higher for Medicaid children than for employer-insured children. Further analysis is recommended that controls for breadth-of-benefit package, severity of illness, and age. Also, differences across plans suggest that research at more than one site is critical for comprehensive policy analyses.

Caries patterns in Head Start children in a fluoridated community.

Abstract: Assessment of caries experience based on the person rather than on the tooth opens the possibility for qualitative descriptions of caries in a population, as well as for the study of specific factors associated with different caries experiences. The study of a Head Start population in adjacent fluoridated communities was divided into two parts. It was the purpose of part one of the study to determine the prevalence of specific caries patterns (presumably associated with different etiologies). Of the children, 39 percent were caries-free; 32 percent had carious lesions only in pit-and-fissure defects of molars; 6.5 percent had carious lesions in hypoplastic defects; 11 percent had facial-lingual lesions, compatible with "nursing caries"; and 11.5 percent had approximal lesions of molars; no child in the study had rampant caries. The second part compared specific lifestyle variables with specific caries patterns. Statistically significant differences or trends were found between caries-free children and those with smooth-surface lesions for mother's educational level, time spent with grandparents, mother's perceived primary reason for cavities, and mother's tendency to permit the child to eat sweets without restriction. No significant differences or trends were found for lifestyle variables between caries-free children and those having lesions associated only with tooth defects.

Characteristics and Trends of Emergency Department Visits in the United States (2010-2014).

Abstract: Background It is important that policy makers, health administrators, and emergency physicians have up-to-date statistics on the most common diagnoses of patients seen in the emergency department (ED). Objectives We sought to describe the changes that occurred in ED visits from 2010 through 2014 and to describe the frequency of different ED diagnoses. Methods This is a retrospective analysis of ED visit data from the National Emergency Department Sample from 2010 through 2014. Visits were stratified by age, sex, insurance status, disposition, diagnosis, and diagnostic category. We calculated the total annual ED visits and the ED visit rates by diagnoses and diagnostic categories. Results Between 2010 and 2014, the number of U.S. ED visits increased from 128.9 million to 137.8 million. The rate of ED Visits per 1000 persons increased from 416.92 (95% confidence interval [CI] 399.47–434.37) in 2010 to 432.51 (95% CI 411.51–453.61) in 2014 (p = 0.0136). ED visits grew twice as quickly (1.7%) as the overall population (0.7%). The most common reason for an ED visit was abdominal pain (11.75% [95% CI 11.61–11.89]). This was followed by mental health problems (4.45% [95% CI 4.19–4.72]). Conclusion The number of ED visits in the United States continues to increase faster than the rate of population growth. Abdominal problems and mental health issues, including substance abuse, were the most common reasons for an ED visit in 2014.

A Measles Outbreak in an Underimmunized Amish Community in Ohio.

Abstract: BackgroundAlthough measles was eliminated in the United States in 2000, importations of the virus continue to cause outbreaks. We describe the epidemiologic features of an outbreak of measles that originated from two unvaccinated Amish men in whom measles was incubating at the time of their return to the United States from the Philippines and explore the effect of public health responses on limiting the spread of measles. MethodsWe performed descriptive analyses of data on demographic characteristics, clinical and laboratory evaluations, and vaccination coverage. ResultsFrom March 24, 2014, through July 23, 2014, a total of 383 outbreak-related cases of measles were reported in nine counties in Ohio. The median age of case patients was 15 years (range, <1 to 53); a total of 178 of the case patients (46%) were female, and 340 (89%) were unvaccinated. Transmission took place primarily within households (68% of cases). The virus strain was genotype D9, which was circulating in the Philippines at the time of ...

The prevalence and risk factors of fluorosis among patients in a pediatric dental practice.

Abstract: Seven hundred eight patients aged 5-19 years in a pediatric practice in North Carolina were selected using a random-start, systematic sampling procedure and enrolled in a case control study to determine risks for fluorosis. Subjects were examined by four trained examiners using the Tooth Surface Index of Fluorosis (TSIF). Information on fluoride exposures and other explanatory variables was obtained through parent interviews and mail questionnaires. Fluoride exposure was confirmed by fluoride assay of community drinking water samples. Bivariate associations for the entire sample were tested using MH chi2 statistic. A secondary analysis controlling for fluoride in drinking water was performed using logistic regression for 233 subjects (116 drinking fluoridated water; 117 drinking fluoride-deficient water) who were lifetime residents at the same address. Nearly 78% of subjects had a TSIF score of > 0; 36.3% > 1; and 18.9% > 2. Twenty-two variables found in bivariate analyses (P < 0.15) to be associated with fluorosis were included in multivariate analyses. For subjects drinking fluoride-deficient water, fluorosis (1 or more positive TSIF scores) was associated with dietary fluoride supplement frequency (OR = 6.5) and age of the child when brushing was initiated (OR = 3.0). For subjects drinking fluoridated water, fluorosis was associated with age of child when brushing was initiated (OR = 3.1).