18-Month well baby visit



18-Month well baby visit

What is it?

18-month-well-baby visits is a rate that refers to the number of children who receive the visit divided by the total number of children one year of age who are registered for health care, expressed as a percent. It is calculated using physician billing claims data from the Ontario Health Insurance Plan (OHIP).

Why is it important?

The 18-month well-baby visit is the last in a series of routine immunization visits for children prior to school entry. This visit is a critical point for primary health care providers to assess the developmental progress of children, including motor skills, communicative abilities and behaviour issues. During this visit, primary care providers can also discuss any potential health concerns with parents and/or caregivers and refer children to specialized services, if necessary. The visit is an important way to identify children at a young age who may be in need of additional public health services and supports.

What does it mean?

Just under 60% of Toronto children received the 18-month well-baby visit in 2015. Figure 1 shows the rate of visits, from 2010 to 2015 combined, by Toronto neighbourhood. The rate ranged from 27% to 75% across the City. Figure 2 shows the rate of 18-month well-baby visits from 2010 to 2015. The rate has increased each year. In 2015, 58% of Toronto children received the visit. Figure 3 shows that children in lower income areas were significantly less likely to receive the visit than children in higher income areas.

Figure 1: Rate of 18-month well-baby visits by neighbourhood, children one year of age, Toronto, 2010 to 2015 combined

Rate of 18-month well-baby visits by neighbourhood, children one year of age, Toronto, 2012 to 2015 combined
Data Notes
In October 2009, the Ontario Ministry of Health and Long Term Care (MOHLTC) and the Ministry of Children and Youth Services introduced new fee codes for the Enhanced 18-Month Well-Baby Visit (otherwise referred to as '18-month well-baby visit'). The visit includes the services rendered when a physician performs all of the following for a child aged 17 to 24 months: (1) those services defined as "well-baby care"; (2) an 18-month age appropriate developmental screen; and (3) review with the child's guardian of a brief standardized tool that aids in the identification of children at risk of development disorder.

Data counts include the number of distinct patients with a valid health card number during this time period. Children without a fixed address and recent newcomers may be missed. These children represent vulnerable populations in Toronto.

The Claims History Database contains service and payment information for fee-for-service claims submitted by physicians and other licensed health professionals. It also includes some of the "shadow billings" by providers in organizations covered by alternate payment arrangements. Since only some of the claims from the MOHLTC's various alternate payment programs or "shadow billers" are included, there may be undercounting of the total volume of certain services. This could include physicians who do not use fee-for-service billing, such as those who work in community health centres (CHCs). In 2014, the 21 CHCs in Toronto provided services to approximately 2,704 or 9% of the children aged 1 to 2 years (Association of Ontario Health Centres, 2016).

Calculation
Numerator: Number of children who receive the 18-month well baby visit
Denominator: Total number of children (one year of age) who are registered for health care

Figure 1
Sources:
Numerator – Medical Services Claims History Database 2010 to 2015, Ontario Ministry of Health and Long Term Care, IntelliHEALTH Ontario, Date Extracted: January 5 2018
Denominator – Ontario Registered Persons Database 2010 to 2015, Ontario Ministry of Health and Long Term Care, IntelliHEALTH Ontario, Date Extracted: January 5 2018.

  • Neighbourhoods are classified into four equal sized groups (quartiles). Map should not be used to infer statistically significant differences between Toronto neighbourhoods.
  • Residence is determined by where the child lives not where the service was provided.
  • Data were summed across multiple years 2012 to 2015 to mitigate the effect of inconsistencies in the numerator and denominator were selected from IntelliHEALTH.
Figure 2
Sources:
Numerator – Medical Services Claims History Database 2010 to 2015, Ontario Ministry of Health and Long Term Care, IntelliHEALTH Ontario, Date Extracted: January 5, 2018
Denominator – Ontario Registered Persons Database 2010 to 2015, Ontario Ministry of Health and Long Term Care, IntelliHEALTH Ontario, Date Extracted: January 9, 2018.

  • Significant differences were estimated using overlapping 95% confidence intervals estimated. Although this method is conservative and most appropriate when comparing mutually exclusive groups, it was chosen as an objective means of making conclusions on population-based data.
Figure 3
Sources:
Numerator – Medical Services Claims History Database 2010 to 2015, Ontario Ministry of Health and Long Term Care, IntelliHEALTH Ontario, Date Extracted: January 5, 2018
Denominator – Ontario Registered Persons Database 2010 to 2015, Ontario Ministry of Health and Long Term Care, IntelliHEALTH Ontario, Date Extracted: January 9, 2018.
Income Quintiles – Statistics Canada – Table F-18 annual income estimates for census families and individuals (T1 Family file), 2015..

  • This income analysis uses five groups, each containing approximately 20% of the population. They were created by ranking Toronto's census tracts based on the percent of residents living below the Statistics Canada after-tax Low Income Measure (LIM). The "Lowest Income" group includes the census tracts with the highest percent of people living below the LIM. The "Highest income" group includes the census tracts with the lowest percent of people living below the LIM. LIM is an income level set at 50% of the median income in Canada in a given year, adjusted for household size.
  • Significant differences were estimated using overlapping 95% confidence intervals. Although this method is conservative and most appropriate when comparing mutually exclusive groups, it was chosen as an objective means of making conclusions on population-based data.