Abstract
Objective
To describe adherence rates for well-child visits among military children in the first
15 months of life and identify any disparities in adherence in a universally insured
population.
Methods
A retrospective cohort analysis was conducted using the Military Health System data
repository which included children who were born between October 2013 and September
2016 and were eligible for TRICARE (the military health insurance program). Children
were followed from zero to fifteen months of life to assess adherence with a national
Health Effectiveness Data and Information Set (HEDIS) metric of 6 well visits during
this period. Differences in adherence rates were evaluated across select demographic
characteristics including sponsor rank, race, age, service branch, patient sex, geographic
region, number of enrollment sites and provider type. Fitted logistic regression models
were used to determine the probability of adherence with the HEDIS metric and identify
disparities.
Results
The final cohort included 168,830 infants. Across all variables, the mean number of
well visits was 6.7 with an overall adherence rate of 86%. Child beneficiaries of
junior enlisted, Black, and Air Force military members had lower adherence with the
HEDIS metric. Enrollment at a single site and having a pediatrician for a primary
care manager was associated with higher rates of adherence.
Conclusions
Sponsor rank, race, and service branch, along with provider type and number of enrollment
sites were significantly associated with the probability of adherence. Further research
should evaluate barriers to care that affect a universally insured population.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic PediatricsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (with CD).National Academies Press, 2003: 12875https://doi.org/10.17226/12875
- The impact of racism on child and adolescent health.Pediatrics. 2019; 144e20191765https://doi.org/10.1542/peds.2019-1765
- Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review.Am J Public Health. 2015; 105: e60-e76https://doi.org/10.2105/AJPH.2015.302903
- Child and adolescent health care quality and disparities: are we making progress?.Acad Pediatr. 2014; 14: 137-148https://doi.org/10.1016/j.acap.2013.11.008
- Racial and ethnic disparities in the health and health care of children.Pediatrics. 2010; 125: e979-e1020https://doi.org/10.1542/peds.2010-0188
- Racial and ethnic disparities in early childhood health and health care.Pediatrics. 2005; 115: e183-e193https://doi.org/10.1542/peds.2004-1474
- Racial differences in antibiotic prescribing by primary care pediatricians.Pediatrics. 2013; 131: 677-684https://doi.org/10.1542/peds.2012-2500
- Racial and ethnic differences in antibiotic use for viral illness in emergency departments.Pediatrics. 2017; 140e20170203https://doi.org/10.1542/peds.2017-0203
- Racial and ethnic differences in pediatric readmissions for common chronic conditions.J Pediatr. 2017; 186: 158-164https://doi.org/10.1016/j.jpeds.2017.03.046
- Well child care in the United States: racial differences in compliance with guidelines.Am J Public Health. 2000; 90: 1436-1443
- Child health disparities: what can a clinician do?.Pediatrics. 2015; 136: 961-968https://doi.org/10.1542/peds.2014-4126
- Health equity and children's rights.Pediatrics. 2010; 125: 838-849https://doi.org/10.1542/peds.2010-0235
- A life course perspective on how racism may be related to health inequities.Am J Public Health. 2012; 102: 967-974https://doi.org/10.2105/AJPH.2012.300666
- Health care quality-improvement approaches to reducing child health disparities.Pediatrics. 2009; 124: S224-S236https://doi.org/10.1542/peds.2009-1100K
- Disparities in pediatric preventive care in the United States, 1993-2002.Arch Pediatr Adolesc Med. 2007; 161: 30-36https://doi.org/10.1001/archpedi.161.1.30
- Association between adolescent preventive care and the role of the Affordable Care Act.JAMA Pediatr. 2018; 172: 43-48https://doi.org/10.1001/jamapediatrics.2017.3140
- Annual report on health care for children and youth in the United States: racial/ethnic and socioeconomic disparities in children's health care quality.Acad Pediatr. 2010; 10: 95-118https://doi.org/10.1016/j.acap.2009.12.005
- Gaps in well-child care attendance among primary care clinics serving low-income families.Pediatrics. 2018; 142e20174019https://doi.org/10.1542/peds.2017-4019
- Compliance with well-child visit recommendations: evidence from the Medical Expenditure Panel Survey, 2000–2002.Pediatrics. 2006; 118: e1766-e1778https://doi.org/10.1542/peds.2006-0286
- Socioeconomic and racial disparities in parental perception and experience of having a medical home, 2007 to 2011–2012.Acad Pediatr. 2017; 17: 95-103https://doi.org/10.1016/j.acap.2016.07.006
- Can equal access to care eliminate racial disparities in pediatric asthma outcomes?.J Asthma. 2008; 45: 211-214https://doi.org/10.1080/02770900801890448
- Reducing healthcare disparities in the military through cultural competence.J Health Hum Serv Adm. 2011; 34: 145-181
- Glycemic control and sponsor rank of military dependents with type 1 diabetes mellitus.Pediatr Diabetes. 2016; 17: 449-457https://doi.org/10.1111/pedi.12306
- Outcomes of follow-up care after an emergency department visit among pediatric asthmatics in the military health system.J Asthma. 2016; 53: 816-824https://doi.org/10.3109/02770903.2016.1170141
- 2019 Demographics Profile of the Military Community.The Office of the Deputy Assistant Secretary of Defense for Military Community and Family Policy, 2019https://download.militaryonesource.mil/12038/MOS/Reports/2019-demographics-report.pdfDate accessed: June 20, 2022
- Racial and ethnic health disparities in TRICARE.J Natl Med Assoc. 2009; 101: 663-676https://doi.org/10.1016/S0027-9684(15)30975-5
- Racial disparities in the military health system: a framework synthesis.Mil Med. 2021; (Published online December 15): usab506https://doi.org/10.1093/milmed/usab506
- No racial disparities in surgical care quality observed after coronary artery bypass grafting in TRICARE patients.Health Aff (Millwood). 2019; 38: 1307-1312https://doi.org/10.1377/hlthaff.2019.00265
- The military oral health care system as a model for eliminating disparities in oral health.J Am Dent Assoc. 2006; 137: 372-378https://doi.org/10.14219/jada.archive.2006.0187
- Racial disparities in outcomes of military and civilian births in California.Arch Pediatr Adolesc Med. 1996; 150: 1062https://doi.org/10.1001/archpedi.1996.02170350064011
- Does universal insurance and access to care influence disparities in outcomes for pediatric patients with osteomyelitis?.Clin Orthop. 2020; 478: 1432-1439https://doi.org/10.1097/CORR.0000000000000994
- Child and Adolescent Well-Care Visits.HEDIS Measures and Technical Resources, 2022https://www.ncqa.org/hedis/measures/child-and-adolescent-well-care-visits/Date accessed: April 14, 2022
- Moving upstream: how interventions that address the social determinants of health can improve health and reduce disparities.J Public Health Manag Pract JPHMP. 2008; 14: S8-17https://doi.org/10.1097/01.PHH.0000338382.36695.42
- Transforming well-child care to meet the needs of families at the intersection of racism and poverty.Acad Pediatr. 2021; 21: S102-S107https://doi.org/10.1016/j.acap.2021.08.004
- Assessing practice pattern differences in the treatment of acute low back pain in the United States Military Health System.BMC Health Serv Res. 2018; 18: 720https://doi.org/10.1186/s12913-018-3525-8
- The Myth of Race: The Troubling Persistence of an Unscientific Idea.Harvard University Press, 2014
Boonyasai R, Azam I, Hahn C, et al. 2021 National Healthcare Quality and Disparities Report. :316.
- Comparison of physician implicit racial bias toward adults versus children.Acad Pediatr. 2017; 17: 120-126https://doi.org/10.1016/j.acap.2016.08.010
- The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma.Am J Public Health. 2012; 102: 988-995https://doi.org/10.2105/AJPH.2011.300621
- Figure 18. Percentage of all active physicians by race/ethnicity,.Diversity in Medicine: Facts and Figures, 2019
Uniformed Services University. What You Need to Know Booklet. Published April 2021. https://www.usuhs.edu/sites/default/files/2021-04/What_You_Need_to_Know.pdf. Accessed July 17, 2022.
- Physician–patient racial concordance and disparities in birthing mortality for newborns.Proc Natl Acad Sci U S A. 2020; 117: 21194-21200https://doi.org/10.1073/pnas.1913405117
- Structural competency: theorizing a new medical engagement with stigma and inequality.Soc Sci Med. 2014; 103: 126-133https://doi.org/10.1016/j.socscimed.2013.06.032
- Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities.J Gen Intern Med. 2013; 28: 1504-1510https://doi.org/10.1007/s11606-013-2441-1
- Implicit bias: what every pediatrician should know about the effect of bias on health and future directions.Curr Probl Pediatr Adolesc Health Care. 2019; 49: 34-44https://doi.org/10.1016/j.cppeds.2019.01.003
- Implicit bias in health professions: from recognition to transformation.Acad Med. 2020; 95: 717-723https://doi.org/10.1097/ACM.0000000000003173
- Enhancing pediatric workforce diversity and providing culturally effective pediatric care: implications for practice, education, and policy making.Pediatrics. 2013; 132: e1105-e1116https://doi.org/10.1542/peds.2013-2268
- Families with TRICARE report lower health care quality and access compared to other insured and uninsured families.Health Aff Proj Hope. 2019; 38: 1377-1385https://doi.org/10.1377/hlthaff.2019.00274
- Racial and ethnic disparities in indicators of a primary care medical home for children.Acad Pediatr. 2009; 9: 221-227https://doi.org/10.1016/j.acap.2009.01.011
Article info
Publication history
Published online: July 30, 2022
Accepted:
July 26,
2022
Received:
February 17,
2022
Footnotes
Declarations of interest: None.
Identification
Copyright
Published by Elsevier Inc. on behalf of Academic Pediatric Association
