biostudies-literatureChien ATAgency for Healthcare Research and QualityNIDDK NIH HHSAHRQ HHSe14199https://www.ebi.ac.uk/biostudies/studies/S-EPMC11250397biostudies-literatureUnknown59(4)<h4>Objective</h4>To investigate primary care practice ownership and specialist-use patterns for commercially insured children with disabilities.<h4>Data sources and study setting</h4>A national commercial claims database and the Health Systems and Provider Database from 2012 to 2016 are the data sources for this study.<h4>Study design</h4>This cross-sectional, descriptive study examines: (1) the most visited type of pediatric primary care physician and practice (independent or system-owned); (2) pediatric and non-pediatric specialist-use patterns; and (3) how practice ownership relates to specialist-use patterns.<h4>Data collection/extraction methods</h4>This study identifies 133,749 person-years of commercially insured children with disabilities aged 0-18 years with at least 24 months of continuous insurance coverage by linking a national commercial claims data set with the Health Systems and Provider Database and applying the validated Children with Disabilities Algorithm.<h4>Principal findings</h4>Three-quarters (75.9%) of children with disabilities received their pediatric primary care in independent practices. Nearly two thirds (59.6%) used at least one specialist with 45.1% using nonpediatric specialists, 28.8% using pediatric ones, and 17.0% using both. Specialist-use patterns varied by both child age and specialist type. Children with disabilities in independent practices were as likely to see a specialist as those in system-owned ones: 57.1% (95% confidence interval [95% CI] 56.7%-57.4%) versus 57.3% (95% CI 56.6%-58.0%), respectively (p = 0.635). The percent using two or more types of specialists was 46.1% (95% CI 45.4%-46.7%) in independent practices, comparable to that in systems 47.1% (95% CI 46.2%-48.0%) (p = 0.054). However, the mean number of specialist visits was significantly lower in independent practices than in systems-4.0 (95% CI 3.9%-4.0%) versus 4.4 (95% CI 4.3%-4.6%) respectively-reaching statistical significance with p < 0.0001.<h4>Conclusions</h4>Recognizing how privately insured children with disabilities use pediatric primary care from pediatric and nonpediatric primary care specialists through both independent and system-owned practices is important for improving care quality and value.Health services researchSpecialist use among privately insured children with disabilities.PMC11250397U19 HS024075-05K01 DK116932U19 HS024075U19 HS024075‐05Cutler DLandrum MBVan Cleave JChien ATFu CBeaulieu NHoutrow AJWisk LEfalseSpecialist use among privately insured children with disabilities.<h4>Objective</h4>To investigate primary care practice ownership and specialist-use patterns for commercially insured children with disabilities.<h4>Data sources and study setting</h4>A national commercial claims database and the Health Systems and Provider Database from 2012 to 2016 are the data sources for this study.<h4>Study design</h4>This cross-sectional, descriptive study examines: (1) the most visited type of pediatric primary care physician and practice (independent or system-owned); (2) pediatric and non-pediatric specialist-use patterns; and (3) how practice ownership relates to specialist-use patterns.<h4>Data collection/extraction methods</h4>This study identifies 133,749 person-years of commercially insured children with disabilities aged 0-18 years with at least 24 months of continuous insurance coverage by linking a national commercial claims data set with the Health Systems and Provider Database and applying the validated Children with Disabilities Algorithm.<h4>Principal findings</h4>Three-quarters (75.9%) of children with disabilities received their pediatric primary care in independent practices. Nearly two thirds (59.6%) used at least one specialist with 45.1% using nonpediatric specialists, 28.8% using pediatric ones, and 17.0% using both. Specialist-use patterns varied by both child age and specialist type. Children with disabilities in independent practices were as likely to see a specialist as those in system-owned ones: 57.1% (95% confidence interval [95% CI] 56.7%-57.4%) versus 57.3% (95% CI 56.6%-58.0%), respectively (p = 0.635). The percent using two or more types of specialists was 46.1% (95% CI 45.4%-46.7%) in independent practices, comparable to that in systems 47.1% (95% CI 46.2%-48.0%) (p = 0.054). However, the mean number of specialist visits was significantly lower in independent practices than in systems-4.0 (95% CI 3.9%-4.0%) versus 4.4 (95% CI 4.3%-4.6%) respectively-reaching statistical significance with p < 0.0001.<h4>Conclusions</h4>Recognizing how privately insured children with disabilities use pediatric primary care from pediatric and nonpediatric primary care specialists through both independent and system-owned practices is important for improving care quality and value.2024-01-01T00:00:00Z2024 Aug2026-03-17T15:29:41.612Z2025-08-16T03:06:57.913ZS-EPMC112503973746118510.1111/1475-6773.14199