Exploring the Enrollment of Children Born With Birth Defects into Michigans Childrens Special Health

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Exploring the Enrollment of Children Born With
Birth Defects into Michigans Childrens Special
Health Care Services (CSHCS) Program

• Jeffrey L. Pollet, MD, MPH
• CSTE/CDC Applied Epidemiology Fellow
• Michigan Department of Community Health

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Background MBDR

• Over 10,000 children in Michigan affected with BD
  each year
• Nearly 140,000 children in registry since
  inception in 1992
• Over 860 reportable conditions
• 564 of these conditions may be CSHCS eligible

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Background CSHCS

• Michigan Definition
• A person under 21 whose activity is or may be so
  restricted by disease or deformity as to reduce
  the individuals normal capacity for education
  and self support.
• Serves 35,000 children per year
• About 1/3 of CSHCS enrollees are children with
  birth defects

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Problem Statement

• Not all children who are eligible for CSHCS
  services will receive benefits
• Varying enrollment rates across state
• What maternal and child parameters are associated
  with CSHCS enrollment?

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Study Questions

• Does birthing hospital level of care predict
  enrollment into CSHCH?
• What additional maternal/child characteristics
  help further predict enrollment into CSHCS?

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Methods Data

• Data
• MBDR / CSHCS linked file
• 1998 through 2003
• Selection Criteria
• Birth defects identifiable at birth
• and
• ICD9 Codes eligible for CSHCS services

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Methods Birth Defects

• Spina Bifida
• Microcephally
• Hydrocephally
• Cleft Lips/Palate
• Limb Reduction Deformities
• Cyanotic Heart Diseases

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Methods - Analysis

• Analysis conducted with SAS 9.1
• Bivariate analysis
• Logistic regression analysis

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Results

• 4240 cases met inclusion criteria
• 60.8 enrollment in CSHCS
• Range 21.4 86.7 enrollment by hospital (39
  hospitals with gt20 cases)

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Discussion
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Discussion
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Discussion
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Discussion
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Discussion - Limitations

• CSHCS Enrollment dependent upon
• Diagnosis
• Referral to program
• Specialist examination
• Parental acceptance of program
• Eligibility

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Conclusion

• Using the linked file containing data from the BD
  registry and the CSHCS program helps identify
  families who underutilize available resources.
• Improvements in referral of eligible children and
  removing enrollment barriers may increase the use
  of CSHCS services.

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Thank You!

• Acknowledgements
• Glenn Copeland, MBA
• Director, Michigan Birth Defects Registry
• State Registrar
• Lorrie Simmons, RHIT
• Quality Improvement Coordinator
• Violanda Grigorescu, MD, MSPH
• State MCH Epidemiologist

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