Analyzing the Effect of
State Legislation on Health Care Utilization for Children With Concussion
State Legislation on Health Care Utilization for Children With Concussion
Gibson
TB., Herring SA., Kutcher JS., Broglio SP. JAMA Pediatrics. Epub ahead of
print.
TB., Herring SA., Kutcher JS., Broglio SP. JAMA Pediatrics. Epub ahead of
print.
Take Home Message: Legislation
regulating pediatric concussion injury management seems to be effective. From
2009-20012 states with legislation had a 92% increase in concussion-related
health care utilization while states without legislation had a 75% increase.
regulating pediatric concussion injury management seems to be effective. From
2009-20012 states with legislation had a 92% increase in concussion-related
health care utilization while states without legislation had a 75% increase.
Washington
enacted the first concussion injury legislation in 2009 (Lystedt Law) and by 2014 all
states had a similar law. This is the first time that laws mandate medical
attention for an injury but it is unclear how these laws affected injury
reporting and health care utilization. Therefore, the authors sought to
evaluate health care utilization rates for concussion from January 1, 2006
through June 30, 2012, in states with and without legislation. The authors
analyzed the MarketScan Commercial Claims and Encounters
database from January 1, 2005 through June 30, 2012. The database includes
health insurance claims from all 50 states and DC. The authors focused on claims
for children aged 12 to 18 years that had a concussion claim code. The authors
assessed prelegislative trends in concussion-related health care utilization
from January 1, 2006 through June 30, 2009, postlegislative trends from July 1,
2009 through June 30, 2012 in states with and without concussion legislation. Compared
to prelegislative trends (2005-2009), the authors found that the rates of
treated concussions in states without legislation were 7% higher in the
2009-2010 school year, 20% higher in the 2010-2011 school year, and 34% higher
in the 2011-2012 school year. During the same time periods, the authors found a
10% increase in health care utilization for concussion in states with
concussion laws compared to those without. From 2009-2012 the rate of office
visits for concussion increased in states without legislation (15-78%) but it was
17% higher in states with laws in effect. However, neurologist visits were not
different between states with and without concussion laws. Similarly, the
authors found no differences between emergency department visits and CT scan
rates between states with and without concussion laws, and the rates remained
unchanged following implementation of the concussion law.
enacted the first concussion injury legislation in 2009 (Lystedt Law) and by 2014 all
states had a similar law. This is the first time that laws mandate medical
attention for an injury but it is unclear how these laws affected injury
reporting and health care utilization. Therefore, the authors sought to
evaluate health care utilization rates for concussion from January 1, 2006
through June 30, 2012, in states with and without legislation. The authors
analyzed the MarketScan Commercial Claims and Encounters
database from January 1, 2005 through June 30, 2012. The database includes
health insurance claims from all 50 states and DC. The authors focused on claims
for children aged 12 to 18 years that had a concussion claim code. The authors
assessed prelegislative trends in concussion-related health care utilization
from January 1, 2006 through June 30, 2009, postlegislative trends from July 1,
2009 through June 30, 2012 in states with and without concussion legislation. Compared
to prelegislative trends (2005-2009), the authors found that the rates of
treated concussions in states without legislation were 7% higher in the
2009-2010 school year, 20% higher in the 2010-2011 school year, and 34% higher
in the 2011-2012 school year. During the same time periods, the authors found a
10% increase in health care utilization for concussion in states with
concussion laws compared to those without. From 2009-2012 the rate of office
visits for concussion increased in states without legislation (15-78%) but it was
17% higher in states with laws in effect. However, neurologist visits were not
different between states with and without concussion laws. Similarly, the
authors found no differences between emergency department visits and CT scan
rates between states with and without concussion laws, and the rates remained
unchanged following implementation of the concussion law.
This
is an important study because it demonstrates the influence of concussion
legislation on concussion care in the youth population. The implementation of
this legislation appears to have been effective in increasing medical attention
devoted to concussion injures in children in the United States. From 2009-20012
states with legislation had a 92% increase in concussion-related health care
utilization while states without legislation had a 75% increase. The authors
estimated that about 40% of the increase in states without the legislation was
related to increased media attention and increased concussion awareness.
Additionally, some concussions in states without laws could have been missed in
this study because athletic trainers were managing the concussion injuries
without a physician visit. The rates of emergency room visits and CT scans
remaining unchanged suggests that parents who are seeking medical attention for
their child are doing so through the appropriate channels. It should be noted
that not all of these concussion cases could be considered sport-related
concussions. Additionally, the authors are only reporting on children with employer-based
insurance, where similar trends may not occur with public sources of insurance
like Medicaid or those with no insurance. Medical personnel should be aware of concussion
laws and their states specificities to continue to increase awareness of concussion
injuries and management.
is an important study because it demonstrates the influence of concussion
legislation on concussion care in the youth population. The implementation of
this legislation appears to have been effective in increasing medical attention
devoted to concussion injures in children in the United States. From 2009-20012
states with legislation had a 92% increase in concussion-related health care
utilization while states without legislation had a 75% increase. The authors
estimated that about 40% of the increase in states without the legislation was
related to increased media attention and increased concussion awareness.
Additionally, some concussions in states without laws could have been missed in
this study because athletic trainers were managing the concussion injuries
without a physician visit. The rates of emergency room visits and CT scans
remaining unchanged suggests that parents who are seeking medical attention for
their child are doing so through the appropriate channels. It should be noted
that not all of these concussion cases could be considered sport-related
concussions. Additionally, the authors are only reporting on children with employer-based
insurance, where similar trends may not occur with public sources of insurance
like Medicaid or those with no insurance. Medical personnel should be aware of concussion
laws and their states specificities to continue to increase awareness of concussion
injuries and management.
Questions for
Discussion: Did concussion laws help to increase concussion awareness? Is it
easier to give concussion care and utilize health care insurance for
concussions following the implementation of this legislation? Should education
and management of other major injuries be regulated by legislation?
Discussion: Did concussion laws help to increase concussion awareness? Is it
easier to give concussion care and utilize health care insurance for
concussions following the implementation of this legislation? Should education
and management of other major injuries be regulated by legislation?
Written by: Jane McDevitt, PhD
Reviewed
by: Jeff Driban
by: Jeff Driban
Related
Posts:
Posts:
Gibson TB, Herring SA, Kutcher JS, & Broglio SP (2014). Analyzing the Effect of State Legislation on Health Care Utilization for Children With Concussion. JAMA Pediatrics PMID: 25531065