34 - Primary and Dental Care Utilization Among Children with Neurodevelopmental Disorders in Federally Qualified Health Centers

Publication Number: 3031.34

Abraham Gallegos, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States; Dina Ghanim, Kaiser Permanente Bernard J. Tyson School of Medicine, Torrance, CA, United States; Rebecca Hill, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States; Rebecca Gambatese, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States; Paul J. Chung, Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, United States; Robert Nocon, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States

Background: Children with neurodevelopmental disorders (NDDs) face barriers to consistent healthcare access, including lower rates of preventive primary and dental care. Federally Qualified Health Centers (FQHCs) serve as a critical access point for medically underserved populations, yet little is known about their role in improving healthcare utilization for children with NDDs.

Objective: To assess whether children with NDDs receiving care at an FQHC have higher odds of well-child visits (WCC) and dental visits compared to those receiving care in non-FQHC settings.

Design/Methods: We conducted a cross-sectional analysis using national Medicaid claims data from 2018, examining children aged 2–18 years diagnosed with NDD. The primary exposure was receiving care at an FQHC. The primary outcomes were (1) at least one WCC in the past year and (2) at least one dental visit in the past year. Multivariable logistic regression models, adjusted for demographic and socioeconomic factors, were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for healthcare utilization.

Results: Among children with NDDs, 67.8% had a well-child visit and 60.3% had an annual dental visit. Children receiving care at FQHCs had higher odds of WCC (OR = 1.28, 95% CI: 1.28–1.29, P < .001) and dental visits (OR = 1.13, 95% CI: 1.12–1.14, P < .001) compared to those in non-FQHC settings. In adjusted models, younger children had higher odds of WCC, and adolescents aged 15–18 years had the lowest odds (OR = 0.23, 95% CI: 0.23–0.23, P < .001). Female children had slightly higher odds of WCC (OR = 1.06, 95% CI: 1.05–1.06, P < .001) and dental visits (OR = 1.12, 95% CI: 1.11–1.12, P < .001) compared to males. Metropolitan residence was associated with higher odds of well-child (OR = 1.34, 95% CI: 1.33–1.35, P < .001) and dental visits (OR = 0.17, 95% CI: 1.16–1.18, P < .001). Children in Medicaid managed care had higher odds of both services compared to those not in managed care.

Conclusion(s): Children with NDDs who receive care at FQHCs have significantly higher well-child and dental care utilization than those in non-FQHC settings. These findings underscore the critical role of FQHCs in improving healthcare access for children with developmental conditions. Policies to expand FQHC services and Medicaid support may further enhance health equity in this population.

Table 1. Demographics and Insurance by FQHC Status (N = 2,391,753)
PAS Abstract Table 1.pdfP values obtained from Pearson’s Chi-squared tests.

Table 2. Adjusted Odds of Well-Child visits, Dental visits, and Fluoride treatment
PAS abstract table 2.pdf*** P < .001
State of residence included as a fixed effect in the adjusted models.