Urban-Rural Disparities in Healthcare Quality for Children with Complex or Disabling Health Conditions

Motivation and Aims:

A total of 11.8 million children live in rural areas of the United States, and one-quarter of these children have chronic health conditions. This population is more likely to have disabilities, less likely to receive preventative care, and more likely to report unmet healthcare needs than children who live in urban areas. As such, they represent an underserved group at high risk for disparities in health outcomes. Children with complex or disabling health conditions may be at particular risk of adverse outcomes when they live in rural areas due to their chronic and multifaceted healthcare needs. However, at a population level we know extremely little about how urban-rural disparities in health care access impact this vulnerable population. The overall objective of this proposal is to comprehensively evaluate urban-rural disparities in health care utilization and quality for children with complex or disabling health conditions using five years of all-payer claims data from three states: Colorado, Massachusetts and New Hampshire. Specific aims:
(i) identify urban-rural disparities in ambulatory, emergency and inpatient healthcare utilization,
(ii) characterize urban-rural disparities in healthcare quality,
(iii) identify community and health-system factors associated with urban-rural disparities in healthcare quality, and
(iv) construct patient-sharing networks among physicians who care for these children to determine how patient-sharing networks differ between rural- and urban-residing children, and whether these differences are associated with disparities in quality of care.

Novel Approach:

• First use of all-payer claims data in the USA to investigate healthcare access and quality for the pediatric population.
• First to explore how physician networks differ between urban- and rural-residing children.
• This research will generate essential data to inform the subsequent implementation and evaluation of interventions to reduce health disparities for rural-residing children with complex or disabling health conditions.

Publications:

Arakelyan M, Freyleue SD, Schaefer AP, Austin AM, Moen EL, O’Malley AJ, Goodman DC, Leyenaar JK. Rural-urban disparities in health care delivery for children with medical complexity and moderating effects of payer, disability, and community poverty. J Rural Health. 2024 Mar;40(2):326-337. doi: 10.1111/jrh.12827. Epub 2024 Feb 20. PubMed PMID: 38379187; PubMed Central PMCID: PMC10954394.

Austin AM, Schaefer AP, Arakelyan M, Freyleue SD, Goodman DC, Leyenaar JK. Specialties Providing Ambulatory Care and Associated Health Care Utilization and Quality for Children With Medical Complexity. Acad Pediatr. 2023 Nov-Dec;23(8):1542-1552. doi: 10.1016/j.acap.2023.07.002. Epub 2023 Jul 17. PubMed PMID: 37468062; PubMed Central PMCID: PMC10792122.

Leyenaar JK, Schaefer AP, Freyleue SD, Austin AM, Simon TD, Van Cleave J, Moen EL, O’Malley AJ, Goodman DC. Prevalence of Children With Medical Complexity and Associations With Health Care Utilization and In-Hospital Mortality. JAMA Pediatr. 2022 Jun 1;176(6):e220687. doi: 10.1001/jamapediatrics.2022.0687. Epub 2022 Jun 6. PMID: 35435932; PMCID: PMC9016603.