Comparing Emergency Department Use Among Medicaid and Commercial Patients Using All-Payer All-Claims Data

Kim, Hyunjee; McConnell, K. John; Sun, Benjamin

doi:10.1089/pop.2016.0075

Cited by 32 publications

(29 citation statements)

References 21 publications

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“…Another study looking at the use of ED among children with AD found that most ED visits were by publicly insured patients [ 52 ]. These findings corroborate those of numerous other studies, suggesting a need for improved utilization and convenient access to primary care and specialty outpatient care for Medicaid recipients [ 53 , 54 ].…”

Section: Discussionsupporting

confidence: 90%

Effects of variations in access to care for children with atopic dermatitis

et al. 2020

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Background An estimated 50% of children in the US are Medicaid-insured. Some of these patients have poor health literacy and limited access to medications and specialty care. These factors affect treatment utilization for pediatric patients with atopic dermatitis (AD), the most common inflammatory skin disease in children. This study assesses and compares treatment patterns and healthcare resource utilization (HCRU) between large cohorts of Medicaid and commercially insured children with AD. Methods Pediatric patients with AD were identified from 2 large US healthcare claims databases (2011–2016). Included patients had continuous health plan eligibility for ≥6 months before and ≥12 months after the first AD diagnosis (index date). Patients with an autoimmune disease diagnosis within 6 months of the index date were excluded. Treatment patterns and all-cause and AD-related HCRU during the observation period were compared between commercially and Medicaid-insured children. Results A minority of children were evaluated by a dermatology or allergy/immunology specialist. Several significant differences were observed between commercially and Medicaid-insured children with AD. Disparities detected for Medicaid-insured children included: comparatively fewer received specialist care, emergency department and urgent care center utilization was higher, a greater proportion had asthma and non-atopic morbidities, high- potency topical corticosteroids and calcineurin inhibitors were less often prescribed, and prescriptions for antihistamines were more than three times higher, despite similar rates of comorbid asthma and allergies among antihistamine users. Treatment patterns also varied substantially across physician specialties. Conclusions Results suggest barriers in accessing specialty care for all children with AD and significant differences in management between commercially and Medicaid-insured children. These disparities in treatment and access to specialty care may contribute to poor AD control, especially in Medicaid-insured patients.

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Section: Discussionsupporting

confidence: 90%

Effects of variations in access to care for children with atopic dermatitis

et al. 2020

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“…Emergency room claims indicated a much lower rate among our program patients, as well as reduced level of ER costs, compared to the control group. However, the rates discovered in this study were much higher than those previously reported in Quittner et al This difference could be because Quittner only included commercially insured patients, while both our program and control groups had a high proportion of managed Medicaid patients, who tend to have high ER utilization …”

Section: Discussioncontrasting

confidence: 69%

Outcome evaluation of a pharmacy‐based therapy management program for patients with cystic fibrosis

Kirkham

Staskon

Hira

et al. 2018

Pediatric Pulmonology

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ObjectiveTo compare medication adherence, pulmonary exacerbations, healthcare utilization, and costs for patients with cystic fibrosis (CF) who utilized a pharmacy‐based therapy management program to a matched control group. We hypothesized that patient management services would be associated with better medication adherence, and thus require fewer visits to the emergency room or hospitalizations.MethodsThis retrospective, observational cohort study used claims data from the MORE2 claims Registry®. The sample consisted of CF patients, aged 6+, who had ≥1 pharmacy claim for inhaled tobramycin, inhaled aztreonam, ivacaftor, or dornase alfa from 6/2/2014‐5/31/2015. Adherence was measured as proportion of days covered (PDC). Propensity score matching and multivariable regression techniques were used to compare outcomes in program participants to matched controls.ResultsOf the 236 intervention and 724 control patients meeting selection criteria, 202 were propensity‐matched from each cohort. Relative to the control cohort, program patients had 23% higher mean PDC for tobramycin (IRR = 1.23, P = 0.01) and were twice as likely to be adherent to tobramycin (PDC ≥ 80%) than matched controls (OR = 2.14, P = 0.04). Program patients had fewer ER visits (IRR = 0.52, P < 0.01) and slightly lower ER costs (IRR = 0.66, P = 0.06) than the control patients.ConclusionA pharmacy‐based therapy management program for CF patients was associated with higher adherence to inhaled tobramycin and lower ER rates. Pharmacies that provide therapy management can support effective CF care management.

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“…This differs from other studies which noted patients with public insurance were more likely to use the ED than patients with other insurance types. [17][18][19][20][21] Only 6% of our study population was uninsured and all ED utilizers had insurance, supporting other findings that lack of insurance likely is not a major factor for ED use for migraine. 4,7,22 There was no statistically significant difference in race between groups, though nonwhite race was found to be more common in ED utilizers in a Georgia study.…”

Section: We Found No Difference In Ed Utilization Between Patients Withsupporting

confidence: 84%

Prescribing practices of migraine‐specific pharmacotherapy associated with emergency department use for migraine

2020

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Objective: This study compared migraine medication prescribing between patients with a migraine diagnosis who used versus did not use the emergency department (ED) for migraine. Background: Headache is the fifth most common chief complaint for ED visits nationwide and the third most common potentially avoidable ED diagnosis in the University of Colorado Health system. The reasons some patients use the ED for migraine management while others do not and whether some ED admissions might be preventable remain unclear. Methods: This retrospective cohort study identified adults with migraine-related diagnoses within 1 year before the index date of July 1, 2018 and compared patient characteristics and migraine medication prescribing patterns between those who did or did not have a subsequent migraine-related ED encounter the following year. ED admission notes were manually reviewed to identify potentially preventable circumstances that led to the ED visit. The primary outcome was the proportion of patients with an active triptan prescription at the index date. Results: Of the 3843 patients identified, 35 patients (0.9%) had a migraine-related ED encounter. Of these, 17/35 (49%) had an active triptan prescription compared to 1360/3808 (36%) of non-ED utilizers (p = 0.114), OR 1.22 (95% CI 0.61-2.45). More ED utilizers had an active prescription for opioids (11/35 [31%] vs. 663/3808 [17%], p = 0.030) and migraine preventive therapy (19/35 [54%] vs. 1149/3808 [30%], p = 0.002), and neurology referrals (20/35 [57%] vs. 654/3808 [17%], p < 0.001) compared to non-ED utilizers. The most common circumstance for migraine-related ED visits was nonresponse to migraine abortive medications administered at home. Conclusions: Triptan prescribing did not differ between ED utilizers and non-ED utilizers for migraine. Overall, less than half of the total patient population had a triptan prescribed. More ED utilizers had neurology referrals, prescriptions for opioids and preventive therapies, and a history of previous ED visit for any reason, which may be markers for higher disease severity or behavior patterns. Future research and interventions to reduce migraine-related ED use could target high-risk patients such as those with previous ED visits for any indication and neurology referrals.

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Comparing Emergency Department Use Among Medicaid and Commercial Patients Using All-Payer All-Claims Data

Cited by 32 publications

References 21 publications

Effects of variations in access to care for children with atopic dermatitis

Effects of variations in access to care for children with atopic dermatitis

Outcome evaluation of a pharmacy‐based therapy management program for patients with cystic fibrosis

Prescribing practices of migraine‐specific pharmacotherapy associated with emergency department use for migraine

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