Predicting Frequent Emergency Department Use by Pediatric Medicaid Patients

Area of Science:

• Pediatrics
• Health Services Research
• Healthcare Management

Background:

• Frequent emergency department (ED) use is a significant concern for healthcare organizations.
• Identifying predictable patient characteristics and utilization patterns is crucial for effective care management.

Purpose of the Study:

• To determine patient characteristics and healthcare utilization patterns predicting frequent ED use (≥4 visits/year) over time in children.
• To identify specific pediatric populations that may benefit most from targeted interventions to reduce ED utilization.

Main Methods:

• Retrospective, population-based study of 13,265 Medicaid children (aged 0-20 years).
• Data collected over two consecutive years (June 2012 - May 2015) from a single pediatric accountable care organization.
• Analysis of year-to-year persistence and individual patient predictability of frequent ED use.

Main Results:

• Year-to-year persistence of frequent ED use was 36.3%, indicating that 'once a frequent user, not always a frequent user'.
• Interventions targeting frequent ED users might appear effective due to natural regression to the mean.
• Predictability of frequent ED use was higher in infants (<1 year old) (0.723) compared to all ages (0.437).

Conclusions:

• Frequent ED use in children demonstrates significant variability, challenging the 'once a frequent user, always a frequent user' assumption.
• Infants under one year old represent a more predictable cohort for frequent ED use, making them a prime target for focused care management interventions.
• Targeted interventions for high-risk pediatric populations, particularly infants, are recommended to optimize healthcare resource allocation and reduce unnecessary ED visits.