723 - Rural-Urban Disparities in Clinical Effort Supporting Children with Medical Complexity: Application of a Novel Measure of Clinician FTE

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 723
Publication Number: 723.105

Andrew P. Schaefer, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, United States; Rebecca Smith, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, NH, United States; Mary Arakelyan, Children's Hospital at Dartmouth-Hitchcock, Lebanon, NH, United States; Seneca D. Freyleue, Geisel School of Medicine at Dartmouth, South Burlington, VT, United States; Andrea Austin, Dartmouth College, East Thetford, VT, United States; David C. Goodman, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; JoAnna Leyenaar, Dartmouth Health, Lebanon, NH, United States

Presenting Author(s)

AS

Andrew P. Schaefer, MA, PhD

Senior Research Programmer / Analyst
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College
Hanover, New Hampshire, United States

Co-Author(s)

JL

JoAnna Leyenaar, MD, PhD, MPH (she/her/hers)

Associate Professor of Pediatrics
Dartmouth Health, United States

Background: One-in-five children in the US live in rural areas, and one-quarter of these have chronic health conditions. Rural-residing children are more likely to report unmet healthcare needs and less likely to receive preventive healthcare than children in urban areas. Children with medical complexity (CMC) may experience unique disparities given their multifaceted healthcare needs. However, the extent to which rural-urban disparities affect CMC healthcare utilization is poorly understood.

Objective: To apply a novel measure of clinician effort spent caring for CMC, and characterize rural-urban disparities in this measure.

Design/Methods: We analyzed all-payer claims data from Colorado, Massachusetts, and New Hampshire, 2012-2017. CMC were identified using conservative applications of the Pediatric Medical Complexity Algorithm and Complex Chronic Condition Classification System. We examined all healthcare encounters with physicians, nurse practitioners, and physicians assistants across care settings. We determined the full time equivalent (FTE) spent providing care to each CMC by linking Current Procedural Terminology codes to work relative value units (wRVU) using Physician Fee Schedule RVU files provided by CMS. wRVUs were then translated into fractional FTEs using mean annual wRVUs from national surveys. Clinical effort was reported as FTE/1000 CMC/year, and rural-urban disparities were determined across CMC sociodemographic and clinical characteristics and using hierarchical linear regression.

Results: Of 178,032 CMC, 11,092 (6.2%) were rural-residing and 166,940 (93.8%) were urban-residing (Table 1). A mean of 4.0 (SD=8.0) clinician FTE/1000 CMC/year was observed, with clinician FTE highest for infants, those assisted by technology, CMC with > 5 body system involvement, CMC with dermatologic and gastrointestinal diseases, and Medicaid-insured (Table 2). In unadjusted analysis, rural-residing CMC had higher mean FTE (4.5, SD=8.4) than urban-residing CMC (4.0, SD=7.9, absolute difference: 0.50, 95%CI=0.35-0.65, p< 0.001). Adjusting for clinical and sociodemographic characteristics, there were no significant differences in clinician FTE between rural- and urban-residing CMC (adjusted absolute difference =-0.04, 95%CI=-0.19-0.09, p=0.52).

Conclusion(s):

We observed substantial variation in clinician effort per CMC based on clinical and demographic characteristics. However, there were no significant differences between rural- and urban-residing CMC in this measure in adjusted analyses, reflecting similar levels of clinician effort spent caring for this vulnerable population.
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