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The impact of adverse childhood experiences on healthcare utilization in children
Afton M Koball1, Sarah E Domoff2, Judy Klevan1
1Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, United States.
Insights
Adverse childhood experiences (ACEs) are linked to increased healthcare utilization, including missed appointments and emergency room visits in children. Insurance status, however, showed a stronger association with healthcare use than ACE scores.
Area of Science:
- Pediatric healthcare research
- Childhood trauma studies
- Public health policy
Background:
- Adverse childhood experiences (ACEs) are known to cause long-term negative health outcomes.
- The specific impact of ACEs on pediatric healthcare utilization remains understudied.
- Understanding this relationship is crucial for developing effective interventions.
Purpose of the Study:
- To investigate the association between ACEs and healthcare utilization in children.
- To analyze the impact of ACEs on medical diagnoses and pharmacological treatments.
- To identify factors influencing healthcare access and use among children with ACEs.
Main Methods:
- Retrospective analysis of electronic health records for 1,183 children aged 6 months to 17 years.
- ACEs were measured using the ACE screening questionnaire.
- Healthcare utilization data, including appointment adherence and emergency service use, were extracted for the year following ACE screening.
Main Results:
- Children with reported ACEs were more likely to miss appointments and use emergency services compared to those without ACEs.
- Higher ACE scores (4+) were associated with increased emergency service use and decreased use of telephone nurse advisors.
- Insurance status demonstrated a more robust association with healthcare utilization than ACE scores.
Conclusions:
- Healthcare systems should consider implementing trauma-informed care initiatives based on these findings.
- Addressing insurance status is a critical step toward improving equitable healthcare utilization for all children.
- Further research can explore tailored interventions for children with ACEs to optimize healthcare engagement.
Background:
Adverse childhood experiences (ACEs) are related to long-term negative outcomes. The impact of these experiences on healthcare utilization in children has been understudied.
Objective:
To examine the impact of ACEs on children's healthcare utilization, medical diagnoses, and pharmacological treatment.
Participants And Setting:
Children aged 6 months to 17 years who were screened for ACEs in the Behavioral Health Department or in primary care locations as part of an initial consultation visit and who had at least one subsequent healthcare visit during the study period were included in the study.
Methods:
Adverse childhood experiences were measured using the ACE screening questionnaire designed by Felitti et al. (1998). Data from the year following administration of the ACE screening tool were retrospectively extracted from the electronic health record.
Results:
Overall, 1,183 children met study inclusion criteria. Children with any reported ACEs were more likely to no show appointments (1-3 ACEs incidence rate ratio (IRR) [95 % confidence interval (CI)]: 1.40 [1.11-1.77]; 4+ ACEs IRR [95 % CI]: 1.41 [1.08-1.84]) and to use emergency services (1-3 ACEs IRR [95 % CI]: 1.24 [1.00-1.53]; 4+ ACEs: IRR [95 % CI]: 1.42 [1.11-1.81) than children with no ACEs. Those with 4+ ACEs used the telephone nurse advisor less frequently (1-3 ACEs IRR [95 % CI]: 0.67 [0.53-0.84]; 4+ ACEs IRR [95 % CI]: 0.69 [0.53-0.90]). Although ACE scores were associated with healthcare utilization, insurance status was more robustly associated with healthcare utilization than ACE score.
Conclusions:
Healthcare systems may employ results from this study to adopt trauma-informed care initiatives. Ensuring that all patients have insurance may be a first step toward improving healthcare utilization.
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