Trends in Asthma Control, Treatment, Health Care Utilization, and Expenditures Among Children in the United States by Place of Residence: 2003-2014

Background Modern, specialized care for children with inflammatory bowel disease (IBD) may have resulted in changes in health services utilization. We report trends over time in health services utilization and surgery for children with IBD and children without IBD. Methods Children diagnosed with IBD <18y between 1994-2013 (n=5518), followed until 2015, in Ontario, Canada were identified from health administrative data, and matched to children without IBD on age, sex, rural/urban household, and income (n=26,677). We report the annual percentage change (APC) with 95% confidence intervals (CI) in the rate of outpatient visits, emergency department (ED) visits, and hospitalizations using negative binomial regression for events within 5 years from the diagnosis/index date. We used Cox proportional hazards regression models to report APC in hazards of intestinal resection (Crohn’s disease; CD) and colectomy (ulcerative colitis; UC). Results IBD-specific hospitalization rates decreased by 2.5% (95% CI 1.8-3.2%) annually, and all-cause hospitalization rates in children without IBD decreased by 4.3% (95% CI 3.5-5.1%) annually. Intestinal resection risk in CD decreased by 6.0% (95% CI 4.6-7.3%) annually and colectomy risk in UC decreased by 3.0% (95% CI 0.7-5.2%) annually. In contrast, IBD-specific outpatient visit rates increased after 2005 by 4.0% (95% CI 3.1-4.9%) annually. Similar trends in outpatient visits were not observed in children without IBD. Conclusions Hospitalizations and surgeries decreased over time while outpatient visits increased after 2005. Decreasing hospitalizations were mirrored in children without IBD, likely resulting from a combination of changes in disease management and health system factors.

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“…In children with other chronic diseases, ED visit use has either decreased 51 , 52 or remained stable. 53 …”

Section: Discussionmentioning

confidence: 99%

Shifting Health Care Use from Hospitalisations and Surgeries to Outpatient Visits in Children with Inflammatory Bowel Disease: A Population-based Cohort Study from Ontario, Canada

Dheri

Kuenzig

Mack

et al. 2021

Journal of Crohn's and Colitis

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“…( 52 ) In addition, poor mental health is associated with poor asthma control. ( 53 )( 54 ) A thorough approach to potential exposures includes care coordination of appropriate referrals (allergist, nutritionist, gastroenterologist, otolaryngologist, mental health consultant), connection to community partners (local organizations that conduct home visits, provide vacuums or mattress and pillow encasements; local housing authority; 1-800-QUITLINE or other smoking cessation assistance), legal advocacy (legal aid to assist the family in advocating for housing remediation if the landlord is not being compliant with housing regulations, local law schools may also have free legal services), social work, and close follow-up for at-risk children. Tailored, comprehensive interventions reduce asthma morbidity rates in at-risk children.…”

Section: Triggers‬‬‬‬‬‬‬‬‬mentioning

confidence: 99%

Asthma

Patel

Teach

2019

Pediatrics in Review

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“…9 Outros estudos têm demonstrado que efetivamente os doentes com asma tem uma elevada taxa de recorrência à Urgência em contexto de agudizações e vários fatores têm sido apontados: baixa adesão terapêutica, informação insuficiente acerca da abordagem da crise e aplicação ineficaz do plano de tratamento na agudização. 20,21 O acesso limitado aos cuidados de saúde primários tem sido um fator comumente associado a um maior número de admissões na UP. 22,23 Contudo, a maioria destes utentes dispõe de um médico de família atribuído e dois terços pertencem a uma unidade de saúde familiar, fatores favoráveis a um melhor acesso aos cuidados de saúde primários.…”

Section: Discussão Conhecer Os Utilizadores Frequentesunclassified

Utilizadores Frequentes da Urgência Pediátrica: Conhecer, Intervir e Analisar - Um Estudo Piloto

et al. 2020

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Introduction: Frequent users contribute to an excessive volume of admissions in the emergency department, impairing the quality of healthcare services. The aim of this study was to identify and characterize the population of frequent users of the pediatric emergencydepartment, establish an individual plan of intervention and evaluate its efficacy.Material and Methods: Intervention study including children and adolescents younger than 16 years, with more than 10 visits in a year to an emergency department of a secondary care hospital. An intervention program was created with a multidisciplinary team and a case manager, who was responsible for the execution of the individual plan of intervention. One year later, the number of visits after the intervention was assessed.Results: We identified 90 patients with a frequent user profile, with 1182 visits. Only 17.3% of the visits had a previous referral. Most of the visits were considered non urgent/less urgent (59%). The intervention included 82 children/adolescents. One year later, there was a significant reduction in the number of visits: median reduction of 62% in 78 participants.Discussion: Most of the visits by frequent users were considered non urgent/less urgent, reflecting a clinically unjustified use of the emergency department. The intervention seems to be effective as the number of visits decreased.Conclusion: This population of frequent users seems to be a heterogeneous group with different problems and levels of complexity. A multidisciplinary and individual intervention, with a case manager, might contribute to reduce the excessive use of the emergency department and improve the provision of health care services to these children.

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Trends in Asthma Control, Treatment, Health Care Utilization, and Expenditures Among Children in the United States by Place of Residence: 2003-2014

Cited by 16 publications

References 15 publications

Shifting Health Care Use from Hospitalisations and Surgeries to Outpatient Visits in Children with Inflammatory Bowel Disease: A Population-based Cohort Study from Ontario, Canada

Shifting Health Care Use from Hospitalisations and Surgeries to Outpatient Visits in Children with Inflammatory Bowel Disease: A Population-based Cohort Study from Ontario, Canada

Asthma

Utilizadores Frequentes da Urgência Pediátrica: Conhecer, Intervir e Analisar - Um Estudo Piloto

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