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Emergency department use among Michigan children with special health care needs: an introductory study
Harold A Pollack1, Kevin J Dombkowski, Janet B Zimmerman
1School of Social Service Administration, 969 East 60th Street, University of Chicago, Chicago, IL 60637, USA. haroldp@uchicago.edu
Insights
Children with dual Medicaid and CSHCS enrollment show high emergency department use, especially infants and those with chronic conditions like asthma or diabetes. Geographic and racial disparities in use persist.
Area of Science:
- Pediatric Health Services Research
- Health Disparities
- Public Health Policy
Background:
- Children dually enrolled in Medicaid and Michigan's Children's Special Health Care Services (CSHCS) represent a vulnerable population with complex health needs.
- Understanding emergency department (ED) utilization patterns is crucial for optimizing care delivery and resource allocation for these children.
- Previous research has not fully elucidated the specific factors driving ED use in this dual-eligible group.
Purpose of the Study:
- To describe patterns of emergency department (ED) use among children dually enrolled in Medicaid and Michigan's Children's Special Health Care Services (CSHCS).
- To identify demographic, diagnostic, and geographic factors associated with high ED utilization in this population.
Main Methods:
- Utilized individual claims and enrollment data from Michigan's Medicaid and CSHCS programs (January 1, 1998, to June 30, 1999).
- Linked claims data with eligibility data to create a comprehensive sample of dual-enrolled children.
- Employed Poisson regression and time-varying hazard analyses to examine ED use rates, controlling for key variables like age, gender, race, and qualifying diagnoses.
Main Results:
- Children under one year, and those with diagnoses including anemia, hemophilia, asthma, epilepsy, and juvenile diabetes, exhibited particularly high ED use rates.
- Significant geographic variations in ED use were observed, even after adjusting for diagnoses and race/ethnicity.
- African American children and Supplemental Security Income (SSI) recipients showed higher rates of ED utilization compared to non-Hispanic white children and other groups, respectively.
Conclusions:
- Dual enrollment in CSHCS and Medicaid signifies children facing intersecting challenges of poverty and chronic illness.
- Observed differences in ED use patterns underscore the critical need for, and the inherent difficulties in, developing effective care systems for managing complex chronic conditions in low-income pediatric populations.
Objective:
To describe patterns of emergency department (ED) use among children dual-enrolled in Medicaid and Michigan's Children's Special Health Care Services (CSHCS).
Data Sources:
Individual claims and enrollment data from Michigan's Medicaid and CSHCS programs for the period January 1, 1998, to June 30, 1999. Claims data were linked with eligibility data and then used to develop a 100 percent sample of claims for individuals enrolled in both Medicaid and CSHCS.
Study Design:
Poisson regression analysis was used to examine the rate of ED use for dual-enrolled children. A time-varying hazard analysis was also used to examine the impact of changes over time. The key variables were gender, age, race, county of residence, Medicaid eligibility category, and qualifying diagnosis.
Principal Findings:
Dual-enrolled children under one year of age, and those with qualifying diagnoses of anemia, hemophilia, asthma, epilepsy, and juvenile diabetes displayed especially high rates of ED use. Significant geographic variation in ED use remained after controlling for qualifying diagnoses, race/ethnicity, and other factors. African Americans displayed higher rates of ED utilization than non-Hispanic whites. Supplemental Security Income (SSI) recipients demonstrated higher utilization than other groups.
Conclusions:
Children dually enrolled in CSHCS and Medicaid face diverse challenges of both poverty and chronic illness. Differences in patterns of use highlight the importance, but also the difficulty, of developing systems of care to manage complex chronic conditions in low-income populations.
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