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J.S. Tootle, W.L. Marsh–Tootle, T.C. Wall; Analysis Of Claims For EPSDT And Visual Acuity Screening In Pediatric Primary Care Settings From Alabama Medicaid . Invest. Ophthalmol. Vis. Sci. 2006;47(13):707.
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To examine rates of visual acuity screening in the medical homes of children aged 3–18 years who were eligible to receive Medicaid from the state of Alabama during fiscal year 2003.
Data from claims filed with a procedure code for an initial or periodic EPSDT or visual acuity screening were obtained from Alabama Medicaid for children aged 3–18 years. The number of children eligible to receive Medicaid benefits was estimated using data from the HCFA 416 form for fiscal year 2003.
Percentages of children receiving EPSDT exams (claims filed / children eligible) were highest for 3 and 4 year–olds, 50% and 55%, respectively, gradually dropped to a stable value of about 30% for ages 7 – 15 years, before dropping monotonically to less that 10% at age 18. The percentage of children with claims for visual acuity (VA claims filed / EPSDT claims) was lowest at age 3 years (11%) but doubled between ages 4 ((23%) and 5 (46%) and reached a constant value slightly above 50% for ages 6 – 15 yrs. About 45% of older teens received VA exams.
Rates of visual acuity screening in the medical home are limited by attendance to EPSDT visits. Efforts to convince primary care providers to perform visual acuity screening would have the greatest impact at pre–school age (potentially doubling coverage from about 25% to 50%), Increased vision screening of pre–schoolers should prove to be an effective intervention to improve school readiness and to prevent permanent vision loss by treating amblyopia. Further improvements in vision screening in the medical home would be more difficult, requiring broader interventions to improve attendance to well child visits.
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