P1083 - Healthcare Disparities in the Military Health System: A Focus on Well-Child Care

Background: Healthcare disparities are preventable differences in illness or injury. They represent barriers to attaining optimal health, and are often experienced by socially disadvantaged or isolated groups within communities. They can additionally be affected by insurance coverage and access to care.

Objective: To describe compliance rates for well child visits among military children in the first 15 months of life, and identify any socio-economic disparities that might exist in a population that is otherwise universally insured, with similar access to care.

Methods: A retrospective cohort analysis was conducted using the military health system data repository (MDR), and included children who were born between October 1, 2013 and September 30, 2016 and were eligible for TRICARE (the military health insurance program). Children were followed from zero to fifteen months of life, to assess compliance with a national Health Effectiveness Data and Information Set (HEDIS) metric of 6 well visits during this time period. Differences in visit compliance rates were evaluated across select demographic characteristics including sponsor rank, race, age, service branch, patient sex, geographic region, number of enrollment sites, clinic and provider type. Fitted logistic regression models were used to determine the probability of compliance with the HEDIS metric and identify disparities. To control for time, we fitted models for each fiscal year of the study period. Odds ratios and corresponding 95% confidence interval were additionally calculated for each model.

Results: The final cohort included 143,488 infants. Across all years, and with respect to each of the variables of interest, the mean number of well visits was greater than six and compliance was at least 82%. Junior enlisted, black, and Air Force beneficiaries were at risk for lower compliance with the HEDIS well child metric. Enrollment at a single site and having a pediatrician for a primary care manager was associated with higher rates of compliance.

Conclusions: Across the TRICARE population, compliance with the HEDIS metric was impressive. Sponsor rank, race, and service branch, along with geographic region, provider type, and number of enrollment sites were significantly associated with the probability of compliance with the metric. Further research should evaluate barriers to care that affect the TRICARE population and identify aspects of TRICARE that contribute to its overall good compliance with this HEDIS metric.