The Journal of Pediatrics
Volume 149, Issue 3 , Pages 354-361, September 2006

The impact of realized access to care on health-related quality of life: A two-year prospective cohort study of children in the California State Children’s Health Insurance Program

RAND Corporation, Santa Monica, California; the Department of Landscape Architecture and Urban Planning, College of Architecture, Department of Pediatrics, College of Medicine, Texas A & M University, College Station, Texas; and the California Managed Risk Medical Insurance Board, Sacramento, CA.

Received 21 November 2005; received in revised form 8 February 2006; accepted 19 April 2006.

Objective

To examine the effect of realized access to care (problems getting care, access to needed care) on health-related quality of life (HRQOL) in the California State Children’s Health Insurance Program.

Study design

This was a prospective cohort study (n = 4,925; 70.5% [3438] had complete data). Surveys were taken at enrollment and after 1 and 2 years in the program. Parents and children reported HRQOL (PedsQL™ 4.0 Generic Core Scales). Repeated-measures analysis accounted for within-person correlation and adjusted for baseline PedsQL™, baseline realized access, race/ethnicity, language, chronic health condition, and having a regular physician.

Results

Realized access to care during the prior year was related to HRQOL for each subsequent year. Foregone care and problems getting care were associated with decrements of 3.5 (P < .001) and 4.5 (P < .001) points for parent proxy-report PedsQL™ and with decrements of 3.2 (P < .001) and 4.4 (P < .001) points for child self-report PedsQL™. Improved realized access resulted in higher PedsQL™ scores, continued realized access resulted in sustained PedsQL™ scores, and foregone care resulted in cumulative declines in PedsQL™ scores.

Conclusions

Realized access to care is associated with statistically significant and clinically meaningful changes in HRQOL in children enrolled in the California State Children’s Health Insurance Program.

Abbreviations:  HF, Healthy Families, California’s SCHIP program , HRQOL, Health-related quality of life , SCHIP, State Children’s Health Insurance Program

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 Supported by a grant from the David and Lucille Packard Foundation. The funding agency played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. Dr Varni holds the copyright and the trademark for the PedsQL™ and receives financial compensation from the Mapi Research Trust, which is a nonprofit research institute that charges distribution fees to for-profit companies that use the Pediatric Quality of Life Inventory™.

PII: S0022-3476(06)00353-2

doi:10.1016/j.jpeds.2006.04.024

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The Journal of Pediatrics
Volume 149, Issue 3 , Pages 354-361, September 2006

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