Pediatric Emergency Department Utilization and Reliance by Insurance Coverage in the United States

Schlichting, Lauren E.; Rogers, Michelle L.; Gjelsvik, Annie; Linakis, James G.; Vivier, Patrick M.

doi:10.1111/acem.13281

Cited by 51 publications

(58 citation statements)

References 22 publications

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“…Consistent with previous study ndings, [32] we found that publicly insured youth were more likely to seek initial concussion-related care at the ED and urgent care than privately insured youth. Previous studies show that publicly insured children are more reliant on the ED for medical care than those with private insurance [32] and that publicly insured pediatric patients increased ED visits relative to privately insured after the passage of concussion laws. [22] We also found that youth with public insurance were less likely than those with private insurance to visit a sports medicine clinic for their initial concussion-related care although the sports medicine clinic remained the main location for the majority of initial concussion visits throughout the study regardless of insurance type.…”

Section: Discussionsupporting

confidence: 92%

Influence of Insurance Type on Rate and Type of Initial Concussion-Related Medical Visits among Youth

Radlicz

Jackson

Hautmann

et al. 2020

Preprint

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Background: A growing number of studies report increased concussion-related health care utilization in recent years, but factors impacting care-seeking behaviors among youth following a concussion are not well described. This study aimed to evaluate the influence of insurance type on the rate and type of initial concussion visits and the time from injury to the initial visit in youth. Methods: We extracted and analyzed initial concussion-related medical visits for youth ages 10 to 17 from electronic health records. Patients must have visited Nationwide Children’s Hospital’s (NCH) concussion clinic at least once between 7/1/2012 and 12/31/2017. We evaluated the trends and patterns of initial concussion visits across the study period using regression analyses.Results: Of 4,955 unique concussion visits included, 60.1% were males, 80.5% were white, and 69.5% were paid by private insurance. Patients’ average age was 13.9 years (SD=3.7). The rate of the initial concussion visits per 10,000 NCH visits was consistently higher in privately insured than publicly insured youth throughout the study period (P < .0001). Privately insured youth had greater odds of initial concussion visits to sports medicine clinics (AOR = 1.45, 95% CI = 1.20, 1.76) but lower odds of initial concussion visits to the ED/urgent care (AOR = 0.74, 95% CI = 0.60, 0.90) than publicly insured youth. Days from injury to initial concussion visit significantly decreased among both insurance types throughout the study (P < .0001), with a greater decrease observed in publicly insured than privately insured youth (P = .011).Conclusions: Results on the differences in the rate, type, and time of initial concussion-related visits may help inform more efficient care of concussion among youth with different types of insurance.

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Section: Discussionsupporting

confidence: 92%

Influence of Insurance Type on Rate and Type of Initial Concussion-Related Medical Visits among Youth

Radlicz

Jackson

Hautmann

et al. 2020

Preprint

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“…We also did a manual search to identify additional papers using the references list of these 15 studies, which did not result in any additional studies matching our review criteria (Figure 1). 32‐46 …”

Section: Resultsmentioning

confidence: 99%

“…The interrater reliability was strong among the two researchers who were involved in the quality assessment (Cohen's kappa = 0.83). We were unable to make a definite assessment for some of the tool's quality measures, but the overall quality of the studies was high 33,34,36‐40,42,44,45 …”

Section: Resultsmentioning

confidence: 99%

Frequent emergency department use in the paediatric population: A systematic literature review

Giannouchos

Washburn

Gary

2020

Evaluation Clinical Practice

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Objective We systematically reviewed the literature on paediatric frequent emergency department (ED) users to identify and to synthesize characteristics and factors associated with frequent ED utilization among this population in the United States. Methods We searched Medline (Ovid), CINAHL (Ebsco), and Embase (Ovid) to identify all relevant studies after 1990. We focused on US studies analysing paediatric frequent ED (PFED) users excluding those focused on specific subgroups. Two reviewers independently selected articles and extracted data on predisposing, enabling, behavioural, need and reinforcing factors. Results Fifteen studies met the inclusion criteria. PFED users comprised 3% to 14% of all paediatric ED users and accounted for 9% to 42% of all paediatric ED visits in 11 studies that defined frequent use as four to six ED visits per year. Most PFED users were less than 5 years old who had public insurance coverage and a regular provider. Public insurance compared to private residency in disadvantaged areas, having at least one chronic or complex condition and a history of hospitalization, were associated with frequent use. Children who had a regular primary care provider were less likely to exhibit frequent ED use. Conclusions Minimizing unnecessary ED visits by frequent utilizers is a quality improvement and cost‐saving priority for health systems. Our findings indicate that many PFED users have greater healthcare needs and face barriers accessing care in a timely manner, even though some have regular providers. To better address the needs of this vulnerable group, health systems should focus on educating caregivers and expanding access to providers in other settings.

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“…A previous study shows a revisit rate of approximately 21% in a representative sample of data from US EDs. 24 Finally, only two hospitals in our study included patients with major trauma which limits generalisability to this subgroup of patients.…”

Section: Limitationsmentioning

confidence: 99%

Sex-specific differences in children attending the emergency department: prospective observational study

et al. 2020

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ObjectiveTo assess the role of sex in the presentation and management of children attending the emergency department (ED).DesignThe TrIAGE project (TRiage Improvements Across General Emergency departments), a prospective observational study based on curated electronic health record data.SettingFive diverse European hospitals in four countries (Austria, The Netherlands, Portugal, UK).ParticipantsAll consecutive paediatric ED visits of children under the age of 16 during the study period (8–36 months between 2012 and 2015).Main outcome measuresThe association between sex (male of female) and diagnostic tests and disease management in general paediatric ED visits and in subgroups presenting with trauma or musculoskeletal, gastrointestinal and respiratory problems and fever. Results from the different hospitals were pooled in a random effects meta-analysis.Results116 172 ED visits were included of which 63 042 (54%) by boys and 53 715 (46%) by girls. Boys accounted for the majority of ED visits in childhood, and girls in adolescence. After adjusting for age, triage urgency and clinical presentation, girls had more laboratory tests compared with boys (pooled OR 1.10, 95% CI 1.05 to 1.15). Additionally, girls had more laboratory tests in ED visits for respiratory problems (pooled OR 1.15, 95% CI 1.04 to 1.26) and more imaging in visits for trauma or musculoskeletal problems (pooled OR 1.10, 95% CI 1.01 to 1.20) and respiratory conditions (pooled OR 1.14, 95% CI 1.05 to 1.24). Girls with respiratory problems were less often treated with inhalation medication (pooled OR 0.76, 95% CI 0.70 to 0.83). There was no difference in hospital admission between the sexes (pooled OR 0.99, 95% CI 0.95 to 1.04).ConclusionIn childhood, boys represent the majority of ED visits and they receive more inhalation medication. Unexpectedly, girls receive more diagnostic tests compared with boys. Further research is needed to investigate whether this is due to pathophysiological differences and differences in disease course, whether girls present signs and symptoms differently, or whether sociocultural factors are responsible.

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Pediatric Emergency Department Utilization and Reliance by Insurance Coverage in the United States

Abstract: Health insurance coverage was associated with overall ED utilization, repeat ED utilization, and EDR. Demographic characteristics, including sex, age, income, and race/ethnicity were important predictors of ED utilization and reliance.

Cited by 51 publications

References 22 publications

Influence of Insurance Type on Rate and Type of Initial Concussion-Related Medical Visits among Youth

Influence of Insurance Type on Rate and Type of Initial Concussion-Related Medical Visits among Youth

Frequent emergency department use in the paediatric population: A systematic literature review

Sex-specific differences in children attending the emergency department: prospective observational study

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