Measures of ED utilization in a national cohort of children

Area of Science:

• Pediatric Health Services Research
• Healthcare Utilization Studies
• Chronic Disease Management

Background:

• Emergency department (ED) utilization is a key indicator of chronic disease control and healthcare quality in children.
• Understanding how different measures of ED utilization capture distinct patient populations is crucial for effective healthcare planning.

Purpose of the Study:

• To determine if two distinct measures of emergency department (ED) utilization identify clinically or demographically different pediatric populations.
• To compare ED reliance (EDR) and ED visit counts as indicators of high ED utilization in children and adolescents.

Main Methods:

• A retrospective cohort study analyzed IBM Health/Truven MarketScan Medicaid data for over 5.4 million children and adolescents.
• Patients were categorized by chronic medical condition complexity using the 3M Clinical Risk Group system.
• High ED utilizers were defined by ED reliance (EDR >0.33) and by visit counts (≥3 ED visits). Logistic regression identified associated patient factors.

Main Results:

• ED reliance (EDR) identified 18% of patients as high utilizers, compared to 7% identified by visit counts.
• The visit count measure identified younger children and those without or with noncomplex chronic diseases as less likely to be high utilizers.
• Conversely, the EDR measure identified older children (≥2 years) and those without or with noncomplex chronic diseases as more likely to be high utilizers.

Conclusions:

• The chosen measure for emergency department (ED) utilization significantly impacts the identification of high-utilizing pediatric populations.
• ED reliance and visit count measures capture clinically and demographically distinct patient groups.
• Future research should carefully consider population medical complexity when selecting ED utilization metrics.