Original Article
Parent caregiver-related predictors of health care service utilization by children with cerebral palsy enrolled in Medicaid*,**,*,**,*,**

Portions of this article were presented at the Association of Health Services Research Annual Meeting, May 2000, in Los Angeles, Calif.
https://doi.org/10.1067/mph.2002.116064Get rights and content

Abstract

Introduction: This study examined the associations between characteristics of the parent caregiver and health care service utilization by children with cerebral palsy enrolled in Medicaid. Methods: A questionnaire was administered to the parents of children with cerebral palsy being treated in a North Carolina hospital, and the responses were linked with health services claims data from Medicaid. Data were available for 93 patients who maintained 1 year of continuous enrollment. The impact of selected demographic variables (race, years the child had the condition, employment, transportation) and behavioral variables (belief the child was receiving appropriate care, willingness to use home nursing and respite services, self-assessment of the severity of the child's condition, and use of orthopedic aids) on the frequency and costs of health care services was explored with use of multiple regression analysis. Results: Parents who were willing to use home nursing and respite services were more likely to utilize these services, as well as inpatient facilities and orthopedic care, for their children (P <.05). However, parents who perceived that their child was receiving adequate care were less likely to utilize orthopedic care and home nursing for their children (P <.05). Discussion: The belief of the parents in the adequacy of care received by their child, as well as their willingness to utilize supplemental health care services, were major predictors of health care service utilization by children with cerebral palsy enrolled in Medicaid. Parents who believed that their children receive enough care may need to be targeted for care management and disease management programs to ensure the continuum of treatment and care for these children. J Pediatr Health Care. (2002). 16, 73-78.

Section snippets

Objectives

This study was designed to be an exploratory empiric analysis of parent caregiver-related factors associated with health care service utilization and charges by children with cerebral palsy enrolled in Medicaid. The associations between select demographic and behavioral characteristics of the parent caregiver and the health care service utilization and charges by children with cerebral palsy receiving Medicaid coverage were examined.

Study population

The subjects of this study were parent caregivers of children with cerebral palsy who were obtaining medical care from the Wake Forest University Medical Center and whose primary insurance coverage provider for the child was North Carolina Medicaid. In 1995 and 1996, a questionnaire administered to parent caregivers of these children collected detailed information about the demographic and behavioral characteristics of the parent. The parents included in this study were all mothers. The survey

Results

The descriptive statistics of the study population of children with cerebral palsy enrolled in Medicaid who were receiving care from the medical center (Table 1) showed striking similarities in health care service utilization to that of similar populations of children with other chronic conditions enrolled in Medicaid (Ireys et al., 1997).

. Descriptive statistics for the study population (n = 93)

VariablesMean (SD) [median]%
Predictor variables
 Age of the child (y)5.3 (3.5) [4.6]
 Caucasian race76
 

Summary and discussion

The study found that two behavioral factors associated with the parent caregiver were most predictive of health care service utilization by children with cerebral palsy enrolled in Medicaid: willing use of supplemental health care services for the child (such as home nursing and respite services), and perception of adequate care. The parent's willingness to use supplemental health care services for the child was associated with an increase in the use of health care services (such as inpatient

Conclusion

Evidence seems to suggest that different perceptions of parent caregivers are associated with the variations in health care service utilization and charges by children with cerebral palsy who are enrolled in Medicaid. The reduction of these differences across parent caregivers could be an important factor in ensuring availability of comprehensive treatment and care management for these children.

References (13)

  • G. Barabas et al.

    Care-load for children and young adults with severe children palsy

    Developmental Medicine & Child Neurology

    (1992)
  • Bureau of Labor Statistics

    Consumer price index summary [On-line]

  • J. Cohen

    Statistical power analysis for the behavioral sciences

    (1972)
  • W.H. Greene

    Econometric analysis

    (1997)
  • H.T. Ireys et al.

    Expenditures for care of children with chronic illnesses enrolled in the Washington State Medicaid Program, fiscal year

    Pediatrics

    (1997)
  • S. Kirk

    Families' experiences of caring at home for a technology-dependent child: A review of the literature

    Child Care Health Development

    (1998)
There are more references available in the full text version of this article.

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Michelle Naughton is Associate Professor at the Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC.

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Beth P. Smith is Associate Professor at the Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.

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Janeen Manuel is Research Associate at the Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC.

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L. Andrew Koman is Professor at the Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC.

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Funded in part by the North Carolina Department of Health and Human Resources, the Cerebral Palsy Foundation, the Orthopedic Research and Education Foundation, and an unrestricted educational grant from Allergan Inc.

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Reprint requests: Rajesh Balkrishnan, PhD, Department of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157.

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