Concussion‐Related Health Care Utilization Among Medicaid Insured Children in Ohio: Rural and Urban Differences

Sullivan, Lindsay; Newton, Alison M.; Shi, Junxin; Chang, Tsung-Chou; Yang, Jingzhen

doi:10.1111/jrh.12484

Cited by 3 publications

(10 citation statements)

References 28 publications

(49 reference statements)

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“…12,14,17,29,31,45,46 Shifts in where patients receive care Concussion care shifted from ED to PO settings over the study period, consistent with recent studies across North America. 13,15,31,47,48 Clinical guidelines advanced by public health and injury prevention bodies over the past decade suggest that care for concussion should include an initial assessment and diagnosis by a medical professional and regular medical follow up for the duration of symptoms. [49][50][51][52][53][54] Our analysis showed increasing rates of follow-up within EOCs, with over three-quarters occurring in outpatient settings.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal trends in incidence and health care use for pediatric concussion in Alberta, Canada

et al. 2022

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Background We described longitudinal trends in the incidence of episodes of care (EOC) and follow-up care for pediatric concussion in relation to age, sex, rurality of patient residence, point of care, and area-based socioeconomic status (SES) in Alberta, Canada. Methods A retrospective population-based cohort study was conducted using linked, province-wide administrative health data for all patients <18 years of age who received a diagnosis of concussion, other specified injuries of head, unspecified injury of head, or post-concussion syndrome between April 1, 2004 and March 31, 2018. Data were geospatially mapped. Results Concussion EOCs increased 2.2-fold over the study period, follow-up visits 5.1-fold. Care was increasingly received in physician office (PO) settings. Concussion diagnoses in rural and remote areas occurred in emergency department (ED) settings more often than in metro centres or urban areas (76%/75% vs. 52%/60%). Proportion of concussion diagnoses was positively related to SES and age. Diagnosis and point of care varied geographically. Conclusions The shift in care to PO settings, increased incidence of all diagnoses, and the higher use of the ED by some segments of the population all have important implications for appropriate clinical management and the efficient provision of health care for pediatric concussion. Impact This is the first study to use EOC to describe longitudinal trends in incidence and follow-up care for pediatric concussion in relation to age, sex, rurality, point of care, and area-based SES. We report increased incidence of concussion in both emergency and outpatient settings and the proportion of diagnoses was positively related to SES and age. Patients increasingly received care for concussion in PO over time. Geospatial mapping indicated that the incidence of concussion and unspecified injury of head varied geographically and temporally. Results have important implications for appropriate clinical management and efficient provision of health care following pediatric concussion.

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Section: Discussionmentioning

confidence: 99%

Longitudinal trends in incidence and health care use for pediatric concussion in Alberta, Canada

et al. 2022

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“…While historical rates generally do not exceed 300/100,000 in developed nations [1,5,6,60,61], Sullivan et al reported overall rates of 440-500/100,000 in 2010, which increased to 730-820/100,000 in 2013 [29]. Modern rural healthcare utilization rates consistently exceed urban rates by 1.1-to 1.3-fold [29,30]. More concerningly, in 2020 Langer et al found that the rate of annual visits in a predominantly rural Canadian province was 1153/100,000 overall, and 5400/100,000 for the high-risk group of ages 0-4 [26].…”

Section: Epidemiologymentioning

confidence: 99%

“…The current update examines important trends in healthcare utilization, provider practices and perceptions, and gaps in care and implementation across EDs, primary care, and school-based settings across two large retrospective studies and three focused survey studies in the US and Canada [29][30][31][32][33].…”

Section: Care Practicesmentioning

confidence: 99%

“…Updated Evidence: Sullivan et al examined trends in healthcare utilization for pediatric concussions in Ohio state, US, between 2008 and 2016 using a large Medicaid insurance claims database [29]. Of 17,008 patients, 34% were rural and 66% urban.…”

Section: Care Practicesmentioning

confidence: 99%

“…Our review found that in developed nations, the recent incidence of concussion in all youths, and notably, 0-4-year-olds are considerably higher than historical reports. While historical rates generally do not exceed 300/100,000 in developed nations [1,5,6,60,61], Sullivan et al reported overall rates of 440-500/100,000 in 2010, which increased to 730-820/100,000 in 2013 [29]. Modern rural healthcare utilization rates consistently exceed urban rates by 1.1-to 1.3-fold [29,30].…”

Section: Epidemiologymentioning

confidence: 99%

See 2 more Smart Citations

Update on Pediatric Mild Traumatic Brain Injury in Rural and Underserved Regions: A Global Perspective

Yue,

Krishnan,

Andrews

et al. 2023

JCM

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Background: Mild traumatic brain injury (MTBI) causes morbidity and disability worldwide. Pediatric patients are uniquely vulnerable due to developmental and psychosocial factors. Reduced healthcare access in rural/underserved communities impair management and outcome. A knowledge update relevant to current gaps in care is critically needed to develop targeted solutions. Methods: The National Library of Medicine PubMed database was queried using comprehensive search terms ((“mild traumatic brain injury” or “concussion”) and (“rural” or “low-income” or “underserved”) and (“pediatric” or “child/children”)) in the title, abstract, and Medical Subject Headings through December 2022. Fifteen articles on rural/underserved pediatric MTBI/concussion not covered in prior reviews were examined and organized into four topical categories: epidemiology, care practices, socioeconomic factors, and telehealth. Results: Incidences are higher for Individuals in rural regions, minorities, and those aged 0–4 years compared to their counterparts, and are increasing over time. Rural healthcare utilization rates generally exceed urban rates, and favor emergency departments (vs. primary care) for initial injury assessment. Management guidelines require customization to resource-constrained settings for implementation and adoption. Decreased community recognition of the seriousness of injury is a consensus challenge to care provision by clinicians. Low parental education and income were correlated with decreased MTBI knowledge and worse outcome. Telehealth protocols for triage/consultation and rehabilitation were feasible in improving care delivery to rural and remote settings. Conclusions: Pediatric MTBI/concussion patients in rural/underserved regions experience increased risks of injury, geographic and financial healthcare barriers, and poorer outcomes. Globally, under-reporting of injury has hindered epidemiological understanding. Ongoing MTBI education should be implemented for rural caregivers, schools, and low-income populations to improve community awareness. Telehealth can improve care delivery across acuity settings, and warrants judicious inclusion in triage and treatment protocols.

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Sports and non-sports-related concussions among Medicaid-insured children: health care utilization before and after Ohio’s concussion law

et al. 2020

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Objective To evaluate patterns of health care utilization for sports-related concussions (SRCs) and non-sports-related concussions (NSRCs) among Medicaid-insured children before and after the enactment of Ohio’s concussion law in April 2013. Methods We analyzed claim data from the Partners For Kids (PFK) Ohio Medicaid database. Concussion diagnoses were identified between April 1, 2008 and June 30, 2017. We compared frequency of concussions by age and sex across the law period. We evaluated type of health care utilization before and after law enactment using multinomial logistic regression. Results Over the 9 year study period, 6157 concussions were included, most of which (70.4%) were NSRCs. The proportion of SRCs increased with age. Among children younger than 5 years old, the majority (96.1%) of concussions were NSRCs. During the post-law period, greater odds of primary care visits than emergency department (ED) visits were observed for both SRCs (OR = 1.53; 95% CI 1.34, 1.75) and NSRCs (OR = 1.73; 95% CI 1.58, 1.90) compared to the pre-law period. Conclusions We observed higher proportions of health care utilization for NSRCs than SRCs in Medicaid insured children and a shift in health care utilization from the ED to primary care in the post-law period. SRCs and NSRCs are likely to have different patterns of health care utilization before and after the enactment of Ohio’s concussion law. Our results demonstrate that Ohio’s youth concussion law had a quantifiable impact on health care utilization.

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Concussion‐Related Health Care Utilization Among Medicaid Insured Children in Ohio: Rural and Urban Differences

Cited by 3 publications

References 28 publications

Longitudinal trends in incidence and health care use for pediatric concussion in Alberta, Canada

Longitudinal trends in incidence and health care use for pediatric concussion in Alberta, Canada

Update on Pediatric Mild Traumatic Brain Injury in Rural and Underserved Regions: A Global Perspective

Sports and non-sports-related concussions among Medicaid-insured children: health care utilization before and after Ohio’s concussion law

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