Early and periodic screening, diagnosis, and treatment and infant health outcomes in Medicaid-insured infants in South Carolina.

摘要

OBJECTIVES: To test the hypothesis that infants experiencing the recommended number of early and periodic screening, diagnosis, and treatment (EPSDT) visits have better health outcomes than infants with fewer visits. STUDY DESIGN: Data represent all health encounters for Medicaid-insured infants of mothers aged at least 18 years in South Carolina, from 2000 to 2002, who were continuously enrolled in fee-for-service insurance (n = 36,662). We examined associations between having at least the recommended number of visits in the first year and health care use in the second year: sick infant doctor visits, emergency department (ED) visits, hospital admissions, and hospitalizations and ED visits for ambulatory care sensitive conditions. RESULTS: Infants with at least the recommended number of EPSDT visits had a higher adjusted rate of sick infant doctor visits (rate ratio, 1.49; 95% CI, 1.41-1.58), but a lower adjusted rate of ED visits for ambulatory care sensitive conditions (rate ratio, 0.94; 95% CI, 0.89-0.99). Having at least the recommended preventive visits did not affect rates of general ED visits or of hospitalizations. CONCLUSIONS: Having at least the recommended number of EPSDT visits may shift some health provision from the ED to physicians' offices.