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 who are registered for health care. 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 concerns. During this visit, primary care providers can also discuss any potential health concerns with 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?

Only slightly more than half of children are receiving the 18-month well-baby visit. Figure 1 shows the rate of visits, from 2010 to 2013 combined, by Toronto neighbourhood. The rate ranged from 25% to 66% across the City. Figure 2 shows the rate of 18-month well-baby visits from 2010 to 2013. While the rate has been increasing each year, in 2013, only 52% of Toronto children received the visit. Figure 3 shows that children in lower income neighbourhoods were significantly less likely to receive the visit than children in higher income neighbourhoods.

Figure 1: Rate of 18-month well-baby visits by neighbourhood, children aged 1 to 2 years, Toronto, 2010 to 2013 combined

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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.

Calculation
Numerator: Number of children who receive the 18-month well baby visit
Denominator: Total number of children (aged 1 to 2 years) who are registered for health care

Figure 1
Sources:
Numerator – Medical Services Claims History Database 2010 to 2013, Ontario Ministry of Health and Long Term Care, IntelliHEALTH ONTARIO, Date Extracted: February 2016
Denominator – Registered Persons Database 2010 to 2013, Ontario Ministry of Health and Long Term Care, IntelliHEALTH ONTARIO, Date Extracted: February 2016.

  • 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 was summed across 2010 to 2013 to mitigate the effect of inconsistencies in how the children in the numerator and denominator were selected from IntelliHEALTH.
Figure 2
Sources:
Numerator – Medical Services Claims History Database 2010 to 2013, Ontario Ministry of Health and Long Term Care, IntelliHEALTH ONTARIO, Date Extracted: February 2016
Denominator – Registered Persons Database 2010 to 2013, Ontario Ministry of Health and Long Term Care, IntelliHEALTH ONTARIO, Date Extracted: February 2016.

  • Significant differences were estimated using overlapping 95% confidence intervals estimated using the Normal distribution. 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 2013, Ontario Ministry of Health and Long Term Care, IntelliHEALTH ONTARIO, Date Extracted: February 2016
Denominator – Registered Persons Database 2010 to 2013, Ontario Ministry of Health and Long Term Care, IntelliHEALTH ONTARIO, Date Extracted: February 2016.
Income Quintiles – Income Estimates for Census Families and Individuals (T1 Family File), Table F-18, Statistics Canada, 2013.

  • This income analysis uses five groups, each containing approximately 20% of the population, 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 estimated using the Normal distribution. 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.
  • Data was summed across 2010 to 2013 to mitigate the effect of inconsistencies in how the children in the numerator and denominator were selected from IntelliHEALTH.