AMBULATORY PEDIATRICS Volume 2, Number 4 279 Copyright  2002 by Ambulatory Pediatric Association July–August 2002 The Burden of Injury in Preschool Children in an Urban Medicaid Managed Care Organization David Bishai, MD, MPH, PhD; Jeanne McCauley, MD, MPH, FACP; Lara B. Trifiletti, MA; Eileen M. McDonald, MS; Brigitte Reeb, MFA; Ruth Ashman, MD; Andrea Carlson Gielen, ScD, ScM Background.—Efforts to control injuries within managed care organization (MCO) populations require information about the incidence and costs associated with the injuries cared for in MCOs. Objective.—This study uses administrative data to measure the rates and the costs of burn, choking, poisoning, blunt, and penetrating injuries in an urban Medicaid MCO. Design/Methods.—A database was assembled from all medical claims submitted to a Medicaid MCO covering chil- dren aged 6 years in urban Baltimore between the dates of July 1, 1997, and August 7, 1999. The database included claims submitted on behalf of 1732 children observed for 2180 person-years. International Classification of Disease–9 codes were reviewed to identify claims for burn, poisoning, choking, and blunt/penetrating injuries. Trained coders reviewed outpatient records to assign E-codes. Results.—A total of 796 injuries occurred. The overall injury rate was 36.5% per year. The total cost of the medical care for these injuries was $863552, or $396 per covered person-year, representing 42%–55% of the capitated rate received in Baltimore. Falls, being struck by something, and cutting/piercing injuries accounted for 68% of injuries. Emergency departments were the most common service sites for injured children for all injuries except in the case of burns. Conclusion.—The children enrolled in this urban Medicaid population had nearly twice the rate of injury when compared to the national average. The medical costs of injuries account for about half of the capitated reimbursement for this age group. Ambulatory Pediatrics 2002;2:279 283 T he growing enrollment of Medicaid-eligible chil- dren in managed care offers a new opportunity to re-examine priorities in the delivery of health care for low-income families. As of June 30, 2000, 18.8 mil- lion Medicaid beneficiaries were enrolled in managed care organizations (MCOs), representing 55% of all beneficia- ries. 1 The potential in managed care to manage the pre- vention and care for injuries and diseases underscores the significance of data-based decision making. Researchers have utilized Medicaid claims data to describe children’s health problems, such as attention deficit disorder, 2 asth- ma, 3 otitis media, 4 and injuries among HIV-infected chil- dren. 5 Busy clinicians juggle many competing priorities in achieving improved pediatric health care. New informa- tion collected by managed care data systems can help es- From the Department of Population and Family Health Sciences and Center for Injury Research and Policy (Dr Bishai), Johns Hop- kins University, Baltimore, Md; the Johns Hopkins Community Phy- sicians (Dr McCauley and Dr Ashman), Baltimore, Md; the De- partment of Health Policy and Management and Center for Injury Research and Policy (Ms Trifiletti, Ms McDonald, and Dr Gielen), Johns Hopkins University, Baltimore, Md; and the Comprehensive Transplant Center (Ms Reeb), Johns Hopkins University, Baltimore, Md. Address correspondence to David Bishai, MD, Department of Pop- ulation and Family Health Sciences and Center for Injury Research and Policy, Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21030 (e-mail: dbishai@ jhu.edu). Received for publication November 1, 2001; accepted March 8, 2002. tablish which activities are of greatest importance to pe- diatricians and MCOs as they care for children and their families. A recent Health Care Financing Administration (HCFA) report on 17 000 children who were hospitalized for injury in a California Medicaid population in 1992 indicated a cost for hospitalizations of $93 million. 6 The HCFA study did not specifically address outpatient care. Studies focusing on the medical costs per injured child, including motor vehicle injuries, estimate the medical costs at $800 per injured child during the period extending from 1987 to 1994. 7 Children aged 0 to 4 years in the National Health Interview Survey had a rate of 19 000 injuries per 100 000 person-years. 7 No study to date has estimated the cost of injury per covered child relative to the capitation rate. This article examines injuries in children from age 0 to 72 months. Providers and MCOs could consider a number of injury control strategies in order to reduce the injury burden in this population, including a clinic-based re- source center, distributing safety products, and enhancing injury prevention counseling efforts. 8,9 Injury prevention activities may offer an opportunity for MCOs to manage health care in a cost-effective manner. Understanding the magnitude of the problem is a first step. No previous studies have documented how much pe- diatric injuries cost MCOs relative to the amount received in capitation. The primary objective of this article is to quantify the burden of injury as costs, service utilization rates, and event rates in an inner-city population of chil- dren insured by a Medicaid MCO.