Measures of ED utilization in a national cohort of children

Andrews, Annie Lintzenich; Bettenhausen, Jessica L.; Hoefgen, Erik R.; Richardson, Troy; Macy, Michelle L.; Zima, Bonnie T.; Colvin, Jeffrey D.; Hall, Matt; Shah, Samir S.; Neff, John M.; Auger, Katherine A.

doi:10.37765/ajmc.2020.43490

Cited by 6 publications

(7 citation statements)

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“… 12 However, this study did not analyze the interactive association of chronic conditions and food insecurity linked to ED utilization. It is essential to examine ED visits because such visits are costly 13 and may represent poor management of chronic conditions, 14 poor quality of care, 15 lack of access to emergent care, 14 and maybe preventable with appropriate primary care. 16 …”

Section: Introductionmentioning

confidence: 99%

Interactive association of chronic illness and food insecurity with emergency department utilization among school‐age children in the United States: A cross‐sectional study

Ghani

Wang

Manning

et al. 2023

Health Science Reports

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Background and Aims: Food insecurity combined with chronic disease conditions is a risk factor for Emergency Department (ED) utilization, an indicator of poor quality of care. However, such an association is not certain among school-age children with chronic conditions. Therefore, we aim to determine the association of food insecurity, chronic conditions, and ED utilization among school-age children in the United States.Methods: We analyzed the data from the 2017 Medical expenditure panel survey (MEPS) among children aged 6-17 years (N = 5518). MEPS data was released electronically by the Agency for Healthcare Research and Quality (AHRQ). We identified four groups of school-age children based on the presence of food security and chronic conditions: 1) with food insecurity and chronic conditions; 2) no food insecurity and chronic conditions; 3) with food insecurity and no chronic conditions; and 4) no food insecurity and no chronic conditions. We compared ED utilization among these four groups using incidence rate ratios (IRR) after adjusting children's age, sex, race and ethnicity, household income, insurance coverage, obesity, and geographic region using count data model, specifically multivariable Poison regression. We used SAS 9.4 and STATA 14.2 for all the data analyses.Results: There were unweighted 5518 school-age children who represented weighted 50,479,419 school-age children in the final analysis. Overall, 6.0% had food insecurity with chronic conditions. These children had higher ED utilization (19.7%) than the other three groups (13.3%, 8.8%, and 7.2%, p < 0.001). The adjusted IRR of ED utilization among school-age children with food insecurity and chronic conditions was 1.90 (95% confidence interval 1.20-3.01, p = 0.007) compared with those with food security and chronic conditions. Conclusion:One in 16 school-age children has both food insecurity and chronic conditions. Food insecurity was positively associated with frequent ED visits in the

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Section: Introductionmentioning

confidence: 99%

Interactive association of chronic illness and food insecurity with emergency department utilization among school‐age children in the United States: A cross‐sectional study

Ghani

Wang

Manning

et al. 2023

Health Science Reports

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“…5 One-fifth of youths visit an ED at least annually. 6 Patients presenting to the ED are more likely than the general population to be at risk for suicide; suicide decedents aged 10 to 24 years were nearly 7 times more likely than living controls to have visited an ED within 30 days prior to their death. 7 A significant proportion of youths seen in pediatric ED settings for physical symptoms have positive screening results for suicide risk.…”

Section: Introductionmentioning

confidence: 99%

“…There is a growing consensus that screening patients seen in emergency departments (EDs) for suicidal risk is an important component of adolescent suicide prevention . One-fifth of youths visit an ED at least annually . Patients presenting to the ED are more likely than the general population to be at risk for suicide; suicide decedents aged 10 to 24 years were nearly 7 times more likely than living controls to have visited an ED within 30 days prior to their death .…”

Section: Introductionmentioning

confidence: 99%

Prediction of Suicide Attempts and Suicide-Related Events Among Adolescents Seen in Emergency Departments

et al. 2023

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ImportanceScreening adolescents in emergency departments (EDs) for suicidal risk is a recommended strategy for suicide prevention. Comparing screening measures on predictive validity could guide ED clinicians in choosing a screening tool.ObjectiveTo compare the Ask Suicide-Screening Questions (ASQ) instrument with the Computerized Adaptive Screen for Suicidal Youth (CASSY) instrument for the prediction of suicidal behavior among adolescents seen in EDs, across demographic and clinical strata.Design, Setting, and ParticipantsThe Emergency Department Study for Teens at Risk for Suicide is a prospective, random-series, multicenter cohort study that recruited adolescents, oversampled for those with psychiatric symptoms, who presented to the ED from July 24, 2017, through October 29, 2018, with a 3-month follow-up to assess the occurrence of suicidal behavior. The study included 14 pediatric ED members of the Pediatric Emergency Care Applied Research Network and 1 Indian Health Service ED. Statistical analysis was performed from May 2021 through January 2023.Main Outcomes and MeasuresThis study used a prediction model to assess outcomes. The primary outcome was suicide attempt (SA), and the secondary outcome was suicide-related visits to the ED or hospital within 3 months of baseline; both were assessed by an interviewer blinded to baseline information. The ASQ is a 4-item questionnaire that surveys suicidal ideation and lifetime SAs. A positive response or nonresponse on any item indicates suicidal risk. The CASSY is a computerized adaptive screening tool that always includes 3 ASQ items and a mean of 8 additional items. The CASSY’s continuous outcome is the predicted probability of an SA.ResultsOf 6513 adolescents available, 4050 were enrolled, 3965 completed baseline assessments, and 2740 (1705 girls [62.2%]; mean [SD] age at enrollment, 15.0 [1.7] years; 469 Black participants [17.1%], 678 Hispanic participants [24.7%], and 1618 White participants [59.1%]) completed both screenings and follow-ups. The ASQ and the CASSY showed a similar sensitivity (0.951 [95% CI, 0.918-0.984] vs 0.945 [95% CI, 0.910-0.980]), specificity (0.588 [95% CI, 0.569-0.607] vs 0.643 [95% CI, 0.625-0.662]), positive predictive value (0.127 [95% CI, 0.109-0.146] vs 0.144 [95% CI, 0.123-0.165]), and negative predictive value (both 0.995 [95% CI, 0.991-0.998], respectively). Area under the receiver operating characteristic curve findings were similar among patients with physical symptoms (ASQ, 0.88 [95% CI, 0.81-0.95] vs CASSY, 0.94 [95% CI, 0.91-0.96]). Among patients with psychiatric symptoms, the CASSY performed better than the ASQ (0.72 [95% CI, 0.68-0.77] vs 0.57 [95% CI, 0.55-0.59], respectively).Conclusions and RelevanceThis study suggests that both the ASQ and the CASSY are appropriate for universal screening of patients in pediatric EDs. For the small subset of patients with psychiatric symptoms, the CASSY shows greater predictive validity.

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“…[1][2][3][4][5] ED use not only reflects a patient's current illness or degree of medical complexity, but is an indicator of their access to primary care and availability of specialist and community-based supports. [6][7][8][9][10] Among all children, infants less than 1 year of age have the highest rates of ED use, 4,7 with recurrent ED use a sign of uncoordinated health care access and economic disparity. 11 ED use in pregnancy is common and is also reflective of poorer access to antenatal care, 12 with worse ensuing maternal and perinatal outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…Emergency departments (EDs) are under enormous strain, with rising use among persons of all ages, especially children and infants . ED use not only reflects a patient’s current illness or degree of medical complexity, but is an indicator of their access to primary care and availability of specialist and community-based supports . Among all children, infants less than 1 year of age have the highest rates of ED use, with recurrent ED use a sign of uncoordinated health care access and economic disparity …”

Section: Introductionmentioning

confidence: 99%

Maternal Emergency Department Use Before Pregnancy and Infant Emergency Department Use After Birth

Varner

Park²,

Ray

2023

JAMA Netw Open

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ImportanceMaternal emergency department (ED) use before or during pregnancy is associated with worse obstetrical outcomes, for reasons including preexisting medical conditions and challenges in accessing health care. It is not known whether maternal prepregnancy ED use is associated with higher use of the ED by their infant.ObjectiveTo study the association between maternal prepregnancy ED use and risk of infant ED use in the first year of life.Design, Setting, and ParticipantsThis population-based cohort study included all singleton livebirths in all of Ontario, Canada, from June 2003 to January 2020.ExposuresAny maternal ED encounter within 90 days preceding the start of the index pregnancy.Main Outcomes and MeasuresAny infant ED visit up to 365 days after the index birth hospitalization discharge date. Relative risks (RR) and absolute risk differences (ARD) were adjusted for maternal age, income, rural residence, immigrant status, parity, having a primary care clinician, and number of prepregnancy comorbidities.ResultsThere were 2 088 111 singleton livebirths; the mean (SD) maternal age was 29.5 (5.4) years, 208 356 (10.0%) were rural dwelling, and 487 773 (23.4%) had 3 or more comorbidities. Among singleton livebirths, 206 539 mothers (9.9%) had an ED visit within 90 days before the index pregnancy. ED use in the first year of life was higher among infants whose mother had visited the ED before pregnancy (570 per 1000) vs those whose mother had not (388 per 1000) (RR, 1.19 [95% CI, 1.18-1.20]; ARD, 91.1 per 1000 [95% CI, 88.6-93.6 per 1000]). Compared with mothers without a prepregnancy ED visit, the RR of infant ED use in the first year was 1.19 (95% CI, 1.18-1.20) if its mother had 1 prepregnancy ED visit, 1.18 (95% CI, 1.17-1.20) following 2 visits, and 1.22 (95% CI, 1.20-1.23) after at least 3 maternal visits. A low-acuity maternal prepregnancy ED visit was associated with an adjusted odds ratio (aOR) of 5.52 (95% CI, 5.16-5.90) for a low-acuity infant ED visit, which was numerically higher than the pairing of a high-acuity ED use between mother and infant (aOR, 1.43, 95% CI, 1.38-1.49).Conclusions and RelevanceIn this cohort study of singleton livebirths, prepregnancy maternal ED use was associated with a higher rate of ED use by the infant in the first year of life, especially for low-acuity ED use. This study’s results may suggest a useful trigger for health system interventions aimed at reducing some ED use in infancy.

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Measures of ED utilization in a national cohort of children

Cited by 6 publications

References 0 publications

Interactive association of chronic illness and food insecurity with emergency department utilization among school‐age children in the United States: A cross‐sectional study

Interactive association of chronic illness and food insecurity with emergency department utilization among school‐age children in the United States: A cross‐sectional study

Prediction of Suicide Attempts and Suicide-Related Events Among Adolescents Seen in Emergency Departments

Maternal Emergency Department Use Before Pregnancy and Infant Emergency Department Use After Birth

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