Predicting Subsequent High-Frequency, Low-Acuity Utilization of the Pediatric Emergency Department
Margaret E Samuels-Kalow1, Matthew W Bryan2, Kathy N Shaw3
1Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass.
Insights
A predictive model can identify children likely to frequently use the pediatric emergency department for low-acuity visits. This helps target interventions to improve healthcare utilization.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Predictive Analytics
Background:
- High-frequency, low-acuity visits to pediatric emergency departments pose a challenge to healthcare resource allocation.
- Developing tools to predict such utilization is crucial for optimizing care pathways.
Purpose of the Study:
- To derive and validate a predictive model for high-frequency (≥4 visits/year), low-acuity (Emergency Severity Index [ESI] 4 or 5) utilization of pediatric emergency departments.
- To identify key predictors available at triage for this specific patient group.
Main Methods:
- Utilized 3 years of data (2012-2014) from a tertiary children's hospital.
- Developed a predictive model using data available at triage, splitting data into derivation and testing sets.
- Included variables with significant univariate association for multivariable modeling.
Main Results:
- A total of 590 (1%) of 61,430 index visits resulted in ≥4 low-acuity visits in the subsequent year.
- The final model included primary care site, age, acuity, previous utilization, race, and insurance.
- The model achieved an area under the receiver operating characteristic curve of 0.84.
Conclusions:
- Triage data can effectively predict subsequent high-frequency, low-acuity pediatric emergency department utilization.
- Further validation and refinement in diverse settings are recommended.
- Electronic risk calculation can facilitate targeted interventions for appropriate healthcare utilization.
Objective:
To derive and test a predictive model for high-frequency (4 or more visits per year), low-acuity (emergency severity index 4 or 5) utilization of the pediatric emergency department.
Methods:
The study sample used 3 years of data (2012-2014) from a single tertiary-care children's hospital for patients <21 years of age. Utilization in 2013 defined the index visit; prior utilization was drawn from 2012; and 2014 was used for outcome measurement. Candidate predictor variables were those that would be available at the time of triage. Data were split into derivation and test sets randomly; variables with a significant univariate association in the derivation set were included for multivariable modeling. The final model from the derivation set was then tested in the validation set, with calculation of a receiver operating characteristic curve.
Results:
There were 90,972 visits in 2013, of which 61,430 were first (index) visits. A total of 590 (1%) had 4 or more triage level 4 or 5 visits in the following year (2014). The final model included site of primary care, age, acuity, previous utilization, race, and insurance, and had an area under the receiver operating characteristic curve of 0.84.
Conclusions:
Data available to the emergency department provider at the time of initial visit triage can predict utilization for low-acuity complaints in the subsequent year. Future work should focus on validation and refinement of the model in additional settings, and electronic calculation of risk status for targeted intervention to improve appropriate utilization of health care services.
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