Initial Emergency Department Visit and Follow-Up Care for Concussions among Children with Medicaid

Abstract

Objective To describe the rates and patterns of initial emergency department (ED) encounters and follow-up care for concussions among Medicaid-insured children before and after the 2013 enactment of Ohio concussion law.Study design Using a time-series design, this study analyzed concussion claim data obtained from Partners for Kids, a pediatric accountable-care organization in Ohio. A total of 12 512 concussions and 48 238 associated claims for services between January 1, 2008, and June 30, 2017, with an initial ED encounter among Medicaid-insured children (ages 0-18 years) were analyzed. The effect of the law on the odds of follow-up care were assessed using generalized estimating equations models, adjusted for sex, age group, and residence location. ResultsOf the total 12 512 concussions, 63.9% occurred in male patients, 70.1% in patients ages 10-18 years, and 65.2% in patients from urban areas. The rate of initial ED encounters for concussions increased from 2008 to 2014 (2.8 to 4.9 per 10 000 members), followed by a decrease in 2016 (4.2 per 10 000 members). A significant increase in follow-up care after the initial ED encounter was observed from pre-law to post-law (OR 1.73, 95% CI 1.61, 1.86). A shift in follow-up care was observed from radiology and ambulance services in pre-law to primary care providers in post-law.Conclusions The Ohio concussion law may have influenced the patterns of initial ED visit and follow-up care for concussions among Medicaid-insured children. Future studies evaluating the impact of the law should analyze the utilization patterns among children with various insurance/payment types. (J Pediatr 2019;206:178-83).

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

“…Concussions were defined using the International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification (ICD-9-CM and ICD-10-CM) codes: 850.0, 850.1, 850.11, 850.12, 850.2, 850.3, 850.4, 850.5, and 850.9, and codes beginning with S06.0 (Gibson et al 2015 ; Tarimala et al 2019 ). Injuries with at least one of the aforementioned concussion diagnosis codes were included in our dataset.…”

“…For patients with multiple concussion-related visits, at least 90 days without a concussion-related visit was required to denote unique injuries (Gibson et al 2015 ). For patients with multiple ED visits, at least 30 days without an ED visit or associated concussion-related visit was required to categorize unique injuries (Tarimala et al 2019 ).…”

Analyzing the impact of a state concussion law using an autoregressive integrated moving average intervention analysis

“…Data used for this study were obtained from the Partners For Kids (PFK) pediatric accountable care organization database which includes the date and type of medical encounter(s), diagnosis, procedure(s), medication(s), treating physician(s), and facilities [ 21 , 22 ]. PFK contracts with Medicaid-managed care plans in 34 counties in central and southeast Ohio, providing healthcare to approximately 330,000 children aged 0 to 21 years.…”

“…To ensure accuracy of the initial concussion-related medical encounter, the study inclusion criteria were defined as follows: (1) an injury was sustained between April 1, 2008 and December 31, 2016, and (2) the patient was continuously enrolled in PFK for at least 30 days prior to the initial concussion-related medical encounter [ 22 ]. For patients with multiple concussion-related encounters, at least 90 days without a concussion-related encounter was required to denote unique injuries.…”

Analyzing the Impact of a State Concussion Law using an Autoregressive Integrated Moving Average Intervention Analysis

“…Visits to multiple medical providers in the same day were treated as one concussionrelated medical encounter. To ensure accuracy of the initial concussion-related medical encounter, the study inclusion criteria were de ned as follows: (1) an injury was sustained between April 1, 2008 and December 31, 2016, and (2) the patient was continuously enrolled in PFK for at least 30 days prior to the initial concussion-related medical encounter [22]. For patients with multiple concussion-related encounters, at least 90 days without a concussion-related encounter was required to denote unique injuries.…”