Impact of Chronic Conditions on Emergency Department Visits of Children Using Medicaid. J Pediatr 2017 Mar;182:267-274
Date
12/17/2016Pubmed ID
27979584Pubmed Central ID
PMC7398048DOI
10.1016/j.jpeds.2016.11.054Scopus ID
2-s2.0-85008178871 (requires institutional sign-in at Scopus site) 35 CitationsAbstract
OBJECTIVE: To assess the impact of chronic conditions on children's emergency department (ED) use.
STUDY DESIGN: Retrospective analysis of 1 850 027 ED visits in 2010 by 3 250 383 children ages 1-21 years continuously enrolled in Medicaid from 10 states included in the Truven Marketscan Medicaid Database. The main outcome was the annual ED visit rate not resulting in hospitalization per 1000 enrollees. We compared rates by enrollees' characteristics, including type and number of chronic conditions, and medical technology (eg, gastrostomy, tracheostomy), using Poisson regression. To assess chronic conditions, we used the Agency for Healthcare Research and Quality's Chronic Condition Indicator system, assigning chronic conditions with ED visit rates ≥75th percentile as having the "highest" visit rates.
RESULTS: The overall annual ED visit rate was 569 per 1000 enrollees. As the number of the children's chronic conditions increased from 0 to ≥3, visit rates increased by 180% (from 376 to 1053 per 1000 enrollees, P < .001). Rates were 174% higher in children assisted with vs without medical technology (1546 vs 565, P < .001). Sickle cell anemia, epilepsy, and asthma were among the chronic conditions associated with the highest ED visit rates (all ≥1003 per 1000 enrollees).
CONCLUSIONS: The highest ED visit rates resulting in discharge to home occurred in children with multiple chronic conditions, technology assistance, and specific conditions such as sickle cell anemia. Future studies should assess the preventability of ED visits in these populations and identify opportunities for reducing their ED use.
Author List
Berry JG, Rodean J, Hall M, Alpern ER, Aronson PL, Freedman SB, Brousseau DC, Shah SS, Simon HK, Cohen E, Marin JR, Morse RB, O'Neill M, Neuman MIMESH terms used to index this publication - Major topics in bold
AdolescentChild
Child, Preschool
Chronic Disease
Cohort Studies
Databases, Factual
Emergency Service, Hospital
Female
Health Care Costs
Health Services Research
Hospitalization
Humans
Infant
Length of Stay
Male
Medicaid
Retrospective Studies
Risk Assessment
United States
