The Association Between Insurance and Transfer of Noninjured Children From Emergency Departments

Huang, Yaoguo; Natale, JoAnne E.; Kissee, Jamie L.; Dayal, Parul; Rosenthal, Jennifer L.; Marcin, James P.

doi:10.1016/j.annemergmed.2016.06.007

Cited by 19 publications

(22 citation statements)

References 34 publications

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“…Finally, financial incentives may encourage transfer because increasing numbers of children are insured by Medicaid, which has been associated with an increased likelihood of transfer. 20,48 Regardless of the causes, care is becoming more concentrated, and fewer patients are receiving definitive care at their first choice of hospital. As pediatric patient complexity increases, transfers will likely continue to increase, with a possible consequence of crowding at regional centers.…”

Section: Discussionmentioning

confidence: 99%

Trends in Capability of Hospitals to Provide Definitive Acute Care for Children: 2008 to 2016

et al. 2019

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BACKGROUND: Provision of high-quality care to acutely ill and injured children is a challenge to US hospitals because many have low pediatric volume. Delineating national trends in definitive pediatric acute care would inform improvements in care. METHODS: We analyzed emergency department (ED) visits by children between 2008 and 2016 in the Nationwide Emergency Department Sample, a weighted sample of 20% of EDs nationally. For each hospital annually, we determined the Hospital Capability Index (HCI) to determine the frequency of definitive acute care, defined as hospitalization instead of ED transfer. Hospitals were classified annually according to 2008 HCI quartiles to understand shifts in pediatric capability. RESULTS: The national median HCI was 0.06 (interquartile range: 0.01-0.17) in 2008 and 0.02 (interquartile range: 0.00-0.09) in 2016 (P , .001). Definitive care became less common regardless of annual pediatric volume, urban or rural designation, or condition frequency. In 2016, 2171 EDs (49.0%) had HCIs ,0.013, which represented the lowest 25% of ED HCIs in 2008. Pediatric visits to EDs categorized in the bottom 2008 capability quartile more than doubled from 2.5 million in 2008 to 5.3 million in 2016. Despite decreasing capability, centers with higher annual pediatric volume and urban centers provided more definitive inpatient care and had fewer inter-ED transfers than lower-volume and rural centers. CONCLUSIONS: Across the United States from 2008 to 2016, hospital provision of definitive acute pediatric care decreased, and ED visits to the hospitals least likely to provide definitive care increased. Systems improvements are needed to support hospital-based acute care of children. WHAT'S KNOWN ON THIS SUBJECT: Definitive care provision has decreased over time in certain states. WHAT THIS STUDY ADDS: Between 2008 and 2016, most hospitals decreasingly provided definitive pediatric acute care and increasingly transferred emergency patients. Low-volume hospitals were least likely to provide definitive care. Pediatric inpatient care is becoming concentrated in fewer centers, decreasing initial access to definitive acute care.

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Section: Discussionmentioning

confidence: 99%

Trends in Capability of Hospitals to Provide Definitive Acute Care for Children: 2008 to 2016

et al. 2019

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“…Outcomes at a post‐transfer hospital were not studied. Encounters with any diagnosis classified as an “injury and poisoning” 15 were excluded given their unique transfer patterns 16,17 . Encounters that resulted in death were also excluded.…”

Section: Methodsmentioning

confidence: 99%

“…Encounters that resulted in death were also excluded. Consistent with prior pediatric transfer research, encounters with Medicare as a primary payer were excluded since Medicare primarily insures adult populations and children who need subspecialized care 17 …”

Section: Methodsmentioning

confidence: 99%

Association between emergency department pediatric readiness and transfer of noninjured children in small rural hospitals

Lieng

Marcin

Sigal

et al. 2021

The Journal of Rural Health

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Purpose Pediatric readiness scores may be a useful measure of a hospital's preparedness to care for children. However, there is limited evidence linking these scores with patient outcomes or other metrics, including the need for interfacility transfer. This study aims to determine the association of pediatric readiness scores with the odds of interfacility transfer among a cohort of noninjured children (< 18 years old) presenting to emergency departments (EDs) in small rural hospitals in the state of California. Methods Data from the National Pediatric Readiness Project assessment were linked with the California Office of Statewide Health Planning and Development's ED and inpatient databases to conduct a cross‐sectional study of pediatric interfacility transfers. Hospitals were manually matched between these data sets. Logistic regression was performed with random intercepts for hospital and adjustment for patient‐level confounders. Findings A total of 54 hospitals and 135,388 encounters met the inclusion criteria. EDs with a high pediatric readiness score (>70) had lower adjusted odds of transfer (aOR: 0.55, 95% CI: 0.33–0.93) than EDs with a low pediatric readiness score (≤ 70). The pediatric readiness section with strongest association with transfer was the “policies, procedures, and protocols” section; EDs in the highest quartile had lower odds of transfer than EDs in the lowest quartile (aOR: 0.54, 95% CI: 0.31–0.91). Conclusions Pediatric patients presenting to EDs at small rural hospitals with high pediatric readiness scores may be less likely to be transferred. Additional studies are recommended to investigate other pediatric outcomes in relation to hospital ED pediatric readiness.

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“…Because trauma patients experience different transfer patterns 17,18 and transfer protocols than nontrauma patients, [19][20][21] we determined a priori that analyses would be stratified on the presence (vs absence) of one or more -2021…”

Section: Statistical Analysesmentioning

confidence: 99%

Emergency Department Pediatric Readiness and Potentially Avoidable Transfers

Lieng

Marcin

Dayal

et al. 2021

The Journal of Pediatrics

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Objective To determine the association between potentially avoidable transfers (PATs) and emergency department (ED) pediatric readiness scores and the score's associated components. Study designThis cross-sectional study linked the 2012 National Pediatric Readiness Project assessment with individual encounter data from California's statewide ED and inpatient databases during the years 2011-2013. A probabilistic linkage, followed by deterministic heuristics, linked pretransfer, and post-transfer encounters. Applying previously published definitions, a transferred child was considered a PAT if they were discharged within 1 day from the ED or inpatient care and had no specialized procedures. Analyses were stratified by injured and noninjured children. We compared PATs with necessary transfers using mixed-effects logistic regression models with random intercepts for hospital and adjustment for patient and hospital covariates.Results After linkage, there were 6765 injured children (27% PATs) and 18 836 noninjured children (14% PATs) who presented to 283 hospitals. In unadjusted analyses, a 10-point increase in pediatric readiness was associated with lower odds of PATs in both injured (OR 0.93, 95% CI 0.90-0.96) and noninjured children (OR 0.90, 95% CI 0.88-0.93). In adjusted analyses, a similar association was detected in injured patients (aOR 0.92, 95% CI 0.86-0.98) and was not detected in noninjured patients (aOR 0.94, 95% CI 0.88-1.00). Components associated with decreased PATs included having a nurse pediatric emergency care coordinator and a quality improvement plan.Conclusions Hospital ED pediatric readiness is associated with lower odds of a PAT. Certain pediatric readiness components are modifiable risk factors that EDs could target to reduce PATs.

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The Association Between Insurance and Transfer of Noninjured Children From Emergency Departments

Cited by 19 publications

References 34 publications

Trends in Capability of Hospitals to Provide Definitive Acute Care for Children: 2008 to 2016

Trends in Capability of Hospitals to Provide Definitive Acute Care for Children: 2008 to 2016

Association between emergency department pediatric readiness and transfer of noninjured children in small rural hospitals

Emergency Department Pediatric Readiness and Potentially Avoidable Transfers

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