Emergency Department Reliance Among Rural Children in Medicaid in New York State

Uva, Jane L.; Wagner, Victoria; Gesten, Foster

doi:10.1111/j.1748-0361.2011.00377.x

Cited by 7 publications

(5 citation statements)

References 11 publications

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“…Fourth, we used rural-urban status (using 2003 Rural-Urban Continuum Codes 29 ) instead of PSSQ as a measure of access on the basis of previous work associating rural-urban status with differences in access and acute care utilization. [30][31][32][33][34][35][36] Finally, we examined pediatric subspecialty supply deciles to explore whether quintiles provided adequate discrimination.…”

Section: Analysesmentioning

confidence: 99%

Supply and Utilization of Pediatric Subspecialists in the United States

et al. 2014

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Section: Analysesmentioning

confidence: 99%

Supply and Utilization of Pediatric Subspecialists in the United States

et al. 2014

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“…[26, 27] Lack of nearby care and distance from definitive care necessitates the use of EMS for many patients in rural communities. [19, 28] Therefore, patients in rural areas may have been less likely to change their healthcare utilization patterns. It will be important to build upon our findings to examine differences in ED and hospital utilization in rural as compared to urban areas throughout the pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…Rural status was categorized as rural vs. urban using rural-urban commuting area (RUCA) codes, where metropolitan areas were classified as urban, while micropolitan areas, small towns, and rural areas were classified as rural. [19][20][21] Race and ethnicity data are not routinely collected during calls and were therefore not included. Missing values for each variable are presented as a separate category ('unknown') and included in the analyses; the rate of missing data was <1% for all included variables.…”

Section: Independent Variablesmentioning

confidence: 99%

Impact of COVID-19 on Emergency Medical Services Utilization and Severity in the U.S. Upper Midwest

Boggust,

McCoy,

Shalom

et al. 2024

Preprint

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The COVID-19 pandemic has claimed nearly one million lives and has drastically changed how patients interact with the healthcare system. Emergency medical services (EMS) are essential for emergency response, disaster preparedness, and responding to everyday emergencies. We therefore examined differences in EMS utilization and call severity in 2020 (pandemic period) compared to trends from 2015-2019 (pre-pandemic period) in a large, multi-state advanced life support EMS agency serving the U.S. Upper Midwest. Specifically, we analyzed all 911 calls made to Mayo Clinic Ambulance, the sole advanced life support EMS provider serving a large area in Minnesota and Wisconsin, in 2020 compared to those made between 2015-2019. We compared the number of emergency calls made in 2020 to the number of calls expected based on trends from 2015-2019. We similarly compared caller demographics, call severity, and proportions of calls made for overdose/intoxication, behavioral health, and motor vehicle accidents. Subgroup analyses were performed for rural vs. urban areas. We identified 262,232 emergent EMS calls in the pre-pandemic period and 53,909 calls in the pandemic period, corresponding to a decrease of 28.7% in call volume during the pandemic period. Caller demographics shifted towards older patients (mean age 59.7 [SD, 23.0] vs. 59.1 [SD, 23.7] years; p<0.001) and to rural areas (20.4% vs. 20.0%; p=0.007). Call severity increased, with 95.3% of calls requiring transport (vs. 93.8%; p<0.001) and 1.9% resulting in death (vs. 1.6%; p<0.001). The proportion of calls for overdose/intoxication increased from 4.8% to 5.5% (p<0.001), while the proportion of calls for motor vehicle collisions decreased from 3.9% to 3.0% (p<0.001). All changes were more pronounced in urban areas. These findings underscore the extent to which the COVID-19 pandemic impacted healthcare utilization, particularly in urban areas, and suggest that patients may have delayed calling EMS with potential implications on disease severity and risk of death.

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“…Pediatricians utilize this encounter to identify unmet healthcare needs, provide parental guidance, and initiate early treatment or referral to mitigate adverse health outcomes [1]. Moreover, adherence to well-child visits has been associated with a lower likelihood of preventable hospitalizations and a reduction in avoidable emergency room visits [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Associations of adverse social determinants of health with missed well-child visits and the role of caregiver social support

Roberts¹,

Kim²,

Martinez³

et al. 2021

J Adv Pediatr Child Health

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Objective: To examine the association between adverse social determinants of health (SDH) and missed well-child visits and the interaction with the level of caregiver social support. Methods: This is a secondary data analysis of data collected from a SDH screening program conducted during well-child visits with referral, navigation and follow-up services for patients. We included 573 adult caregivers who accompanied patients aged 0-5 years to well-child visits and completed the screening from August 2017 to May 2018. The caregivers reported financial hardship, food insecurity, housing challenges, childcare difficulty, transportation issues, insurance difficulty, job difficulty, and education needs. Our primary outcome was a no-show (i.e., missed) to a well-child visit. Social support was dichotomized as low or high. Results: Among 573 patients who completed the screening, 335 patients (76.4%) had at least one social need. Financial hardship (p = 0.006), housing instability (p = 0.002), and no/poor childcare (p = 0.03) were associated with missed well-child visits. In multivariable regression analysis, having Medicaid (aOR = 1.91 [1.17-3.10]) and unstable housing (aOR = 6.79 [1.35-34.70]) were both associated with missed well-child visits. However, when social support was added to the multivariable logistic model, both Medicaid and unstable housing were no longer associated with missed well-child visits. Conclusion: Adverse SDH such as financial hardship, housing instability, and childcare difficulty were associated with missed well-child visits. However, with the addition of social support, this association was no longer significant. This study supports the hypothesis that high social support may mitigate the association between well-child visits among families experiencing adverse SDH.

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Emergency Department Reliance Among Rural Children in Medicaid in New York State

Abstract: ED reliance is associated with rural residence. Increased access to primary and specialty care in rural settings could help reduce EDR, particularly among rural adolescents.

Cited by 7 publications

References 11 publications

Supply and Utilization of Pediatric Subspecialists in the United States

Supply and Utilization of Pediatric Subspecialists in the United States

Impact of COVID-19 on Emergency Medical Services Utilization and Severity in the U.S. Upper Midwest

Associations of adverse social determinants of health with missed well-child visits and the role of caregiver social support

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