PATTERNS OF CARE RECEIVED BY MEDICAID RECIPIENTS WITH URINARY-TRACT INFECTIONS

Background. Urinary tract infections (UTIs) occur commonly in children and may lead to substantial morbidity. Most experts recommend urine c ultures for diagnosing UTIs in children. In addition, most experts rec ommend imaging studies in a portion of children diagnosed with UTIs. P urpose. The purpose of this study was to assess how rates of performan ce of urine cultures and imaging studies for children in the Alabama M edicaid program diagnosed with a UTI vary by patient demographics, pro vider characteristics, and service locations. Methods. The study desig n was a retrospective review of Alabama Medicaid claims data. Children were included as UTI cases if they had a Medicaid claim for urinary t ract infections during 1991, were continuously enrolled in Medicaid fo r that year, and were younger than 8 years of age. Claims were grouped into episodes of care, and episodes were assigned to a diagnosing phy sician. Physician locations were classified as rural, suburban, or urb an using demographic data. Specific laboratory and imaging procedures were identified using CPT codes (Physician's Current Procedural Techno logy Codes, 4th Edition). Results. We identified 404 episodes of UTI o ccurring in 380 children. Only 47% of episodes were associated with cl aims for urine cultures. Claims for urine cultures were more frequentl y filed by pediatricians in urban locations. In the subset of 114 pati ents with multiple UTI episodes, only 68% had imaging studies specific for the urinary tract. Only 44% received both a voiding cystourethrog ram and renal ultrasound. Conclusions. Claims data suggest that physic ians underuse urine cultures in diagnosing UTIs in Alabama pediatric M edicaid recipients. Urban-based pediatricians perform better than othe r types of physicians. Imaging studies are also used less frequently t han is commonly recommended.