Healthcare Utilization and Spending for Constipation in Children with Versus Without Complex Chronic Conditions.

Objectives: (1) To examine the prevalence of diagnosis and treatment for constipation among children receiving Medicaid. (2) To compare healthcare utilization and spending for constipation among children based on number of complex chronic conditions (CCCs). Methods: Retrospective cohort study of 4.9 million children aged 1 to 17 years enrolled in Medicaid from 2009-2011 in 10 states in the Truven Marketscan(R) Database. Constipation was identified using ICD-9 codes for constipation (564.0x), intestinal impaction (560.3x) or encopresis (307.7). Outpatient and inpatient utilization and spending for constipation were assessed. CCC status was identified using validated methodology. Results: 267,188 children (5.4%) were diagnosed with constipation. Total constipation spending was $79.5 million. Outpatient constipation spending was $66.8 million (84.1%) over 406,814 visits, mean spending $120/visit. Among children with constipation, 1,363 (0.5%) received inpatient treatment, accounting for $12.2 million (15.4%) of constipation spending, mean spending $7,815/hospitalization. Of children hospitalized for constipation, 552 (40.5%) did not have an outpatient visit for constipation prior to admission. 6.8% of children in the study had > 1 CCC; these children accounted for 33.5% of total constipation spending, 70.3% of inpatient constipation spending, and 19.8% of emergency department (ED) constipation spending. Constipation prevalence was 11.0% for children with 1 CCC, 16.6% with 2 CCCs and 27.1% with >=3 CCCs. Conclusions: Although the majority of pediatric constipation treatment occurs in the outpatient setting, inpatient care accounts for a sizable percentage of spending. Children with CCCs have a higher prevalence of constipation and account for a disproportionate amount of constipation healthcare utilization and spending. (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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