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Health Care Use by Children Diagnosed as Having Developmental Delay
Margaret M. Gallaher, MD, MPH;
Dimitri A. Christakis, MD, MPH;
Frederick A. Connell, MD, MPH
Arch Pediatr Adolesc Med. 2002;156:246-251.
Background Although children with developmental delay are known to have increased
health care use, it is unclear what proportion of that health care use is
related to associated chronic health conditions.
Objectives To assess the prevalence of isolated developmental delay and to determine
the role of developmental delay in health care use controlling for chronic
health conditions.
Design Retrospective cohort study using Washington State Medicaid claims records
from November 1, 1990, to December 31, 1997, an administrative data set that
contains both International Classification of Diseases,
Ninth Revision, Clinical Modification codes and billed services.
Patients and Setting Children born between November 1, 1990, and December 31, 1992, diagnosed
as having developmental delay before the age of 5 years, enrolled in Medicaid
within 1 month of birth, and continuously enrolled for at least 12 months.
Four control subjects per case were matched on date of birth and duration
of continuous enrollment in Medicaid.
Main Outcome Measures Visits to physicians, emergency departments, other practitioners, or
hospitals by year of life.
Results One thousand two hundred forty-two children having developmental delay
and 5370 children without developmental delay were included. One percent of
those who met study criteria had developmental delay without chronic health
conditions and 30% of the children with developmental delay had no associated
chronic health conditions. Boys were 1.6 times as likely to have a diagnosis
of developmental delay. Developmental delay was independently associated with
increased health care use by all 4 measures used.
Conclusion Developmental delay increases health care use apart from associated
chronic health conditions.
From the Department of Pediatrics and the Child Health Institute, University
of Washington, Seattle. Dr Gallaher is now with Children's Medical Services,
New Mexico Department of Health, Santa Fe.
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