Patterns of healthcare utilisation in children and young people: a retrospective cohort study using routinely collected healthcare data in Northwest London
Objectives With a growing role for health services in managing population health, there is a need for early identification of populations with high need. Segmentation approaches partition the population based on demographics, long-term conditions (LTCs) or healthcare utilisation but have mostly been...
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BMJ Publishing Group
2021-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/12/e050847.full |
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| author | Dougal S Hargreaves Mitch Blair Thomas Woodcock Jonathan Clarke Mauricio Barahona Rachel McCarthy Kavitha Saravanakumar |
| author_facet | Dougal S Hargreaves Mitch Blair Thomas Woodcock Jonathan Clarke Mauricio Barahona Rachel McCarthy Kavitha Saravanakumar |
| author_sort | Dougal S Hargreaves |
| collection | DOAJ |
| description | Objectives With a growing role for health services in managing population health, there is a need for early identification of populations with high need. Segmentation approaches partition the population based on demographics, long-term conditions (LTCs) or healthcare utilisation but have mostly been applied to adults. Our study uses segmentation methods to distinguish patterns of healthcare utilisation in children and young people (CYP) and to explore predictors of segment membership.Design A retrospective cohort study.Setting Routinely collected primary and secondary healthcare data in Northwest London from the Discover database.Participants 378 309 CYP aged 0–15 years registered to a general practice in Northwest London with 1 full year of follow-up.Primary and secondary outcome measures Assignment of each participant to a segment defined by seven healthcare variables representing primary and secondary care attendances, and description of utilisation patterns by segment. Predictors of segment membership described by age, sex, ethnicity, deprivation and LTCs.Results Participants were grouped into six segments based on healthcare utilisation. Three segments predominantly used primary care, two moderate utilisation segments differed in use of emergency or elective care, and a high utilisation segment, representing 16 632 (4.4%) children accounted for the highest mean presentations across all service types. The two smallest segments, representing 13.3% of the population, accounted for 62.5% of total costs. Younger age, residence in areas of higher deprivation and the presence of one or more LTCs were associated with membership of higher utilisation segments, but 75.0% of those in the highest utilisation segment had no LTC.Conclusions This article identifies six segments of healthcare utilisation in CYP and predictors of segment membership. Demographics and LTCs may not explain utilisation patterns as strongly as in adults, which may limit the use of routine data in predicting utilisation and suggest children have less well-defined trajectories of service use than adults. |
| format | Article |
| id | doaj-art-a9d99cdcc5a34a1ca5491eaa041f9fd8 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-a9d99cdcc5a34a1ca5491eaa041f9fd82025-08-20T01:56:01ZengBMJ Publishing GroupBMJ Open2044-60552021-12-01111210.1136/bmjopen-2021-050847Patterns of healthcare utilisation in children and young people: a retrospective cohort study using routinely collected healthcare data in Northwest LondonDougal S Hargreaves0Mitch Blair1Thomas Woodcock2Jonathan Clarke3Mauricio Barahona4Rachel McCarthy5Kavitha Saravanakumar66 Mohn Centre for Children`s Health and Wellbeing, Imperial College London, London, UK4 Department of Paediatrics and Child Health, Northwick Park Hospital, Harrow, UKNational Institute for Health Research Applied Research Collaboration Northwest London, Imperial College London, London, UKDepartment of Mathematics, Imperial College London, London, UKDepartment of Mathematics, Imperial College London, London, UKNorth West London Collaboration of Clinical Commissioning Groups, London, UKNorth West London Collaboration of Clinical Commissioning Groups, London, UKObjectives With a growing role for health services in managing population health, there is a need for early identification of populations with high need. Segmentation approaches partition the population based on demographics, long-term conditions (LTCs) or healthcare utilisation but have mostly been applied to adults. Our study uses segmentation methods to distinguish patterns of healthcare utilisation in children and young people (CYP) and to explore predictors of segment membership.Design A retrospective cohort study.Setting Routinely collected primary and secondary healthcare data in Northwest London from the Discover database.Participants 378 309 CYP aged 0–15 years registered to a general practice in Northwest London with 1 full year of follow-up.Primary and secondary outcome measures Assignment of each participant to a segment defined by seven healthcare variables representing primary and secondary care attendances, and description of utilisation patterns by segment. Predictors of segment membership described by age, sex, ethnicity, deprivation and LTCs.Results Participants were grouped into six segments based on healthcare utilisation. Three segments predominantly used primary care, two moderate utilisation segments differed in use of emergency or elective care, and a high utilisation segment, representing 16 632 (4.4%) children accounted for the highest mean presentations across all service types. The two smallest segments, representing 13.3% of the population, accounted for 62.5% of total costs. Younger age, residence in areas of higher deprivation and the presence of one or more LTCs were associated with membership of higher utilisation segments, but 75.0% of those in the highest utilisation segment had no LTC.Conclusions This article identifies six segments of healthcare utilisation in CYP and predictors of segment membership. Demographics and LTCs may not explain utilisation patterns as strongly as in adults, which may limit the use of routine data in predicting utilisation and suggest children have less well-defined trajectories of service use than adults.https://bmjopen.bmj.com/content/11/12/e050847.full |
| spellingShingle | Dougal S Hargreaves Mitch Blair Thomas Woodcock Jonathan Clarke Mauricio Barahona Rachel McCarthy Kavitha Saravanakumar Patterns of healthcare utilisation in children and young people: a retrospective cohort study using routinely collected healthcare data in Northwest London BMJ Open |
| title | Patterns of healthcare utilisation in children and young people: a retrospective cohort study using routinely collected healthcare data in Northwest London |
| title_full | Patterns of healthcare utilisation in children and young people: a retrospective cohort study using routinely collected healthcare data in Northwest London |
| title_fullStr | Patterns of healthcare utilisation in children and young people: a retrospective cohort study using routinely collected healthcare data in Northwest London |
| title_full_unstemmed | Patterns of healthcare utilisation in children and young people: a retrospective cohort study using routinely collected healthcare data in Northwest London |
| title_short | Patterns of healthcare utilisation in children and young people: a retrospective cohort study using routinely collected healthcare data in Northwest London |
| title_sort | patterns of healthcare utilisation in children and young people a retrospective cohort study using routinely collected healthcare data in northwest london |
| url | https://bmjopen.bmj.com/content/11/12/e050847.full |
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