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Low-Resource Emergency Department Visits for Children With Complex Chronic Conditions
Christian D Pulcini1, Ryan J Coller2, Michelle L Macy3
1From the Department of Surgery and Pediatrics, University of Vermont Medical Center and Children's Hospital, University of Vermont Larner College of Medicine, Burlington, VT.
Insights
Infants with complex chronic conditions (CCC) visiting the emergency department (ED) during the day and living nearby are more likely to have low-resource visits. These findings highlight potential areas for improving care coordination and reducing unnecessary ED use.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Chronic Disease Management
Background:
- Reducing emergency department (ED) utilization is a priority for children with complex chronic conditions (CCC).
- Low-resource ED visits, characterized by minimal clinical intervention and no hospital admission, represent a potentially avoidable use of healthcare resources.
Purpose of the Study:
- To identify demographic, clinical, and health service factors associated with low-resource ED visits in children with CCC.
- To inform strategies aimed at optimizing ED resource allocation and care pathways for this vulnerable population.
Main Methods:
- Retrospective analysis of 271,806 ED visits between 2014 and 2017 for patients with CCC.
- Defined low-resource ED visits as those with no medications, labs, procedures, or diagnostic tests, and no hospital admission.
- Utilized chi-squared tests and generalized linear models to determine factors associated with low-resource ED visits.
Main Results:
- Sixteen percent of ED visits for children with CCC were classified as low-resource.
- Infants (0 years) had significantly higher odds of low-resource ED visits compared to older children (OR, 3.9).
- Proximity to the ED (<5 miles) and daytime/evening presentation were also associated with increased likelihood of low-resource visits.
Conclusions:
- Infant age, geographic proximity to the ED, and visit timing (day/evening) are key factors associated with low-resource ED visits in children with CCC.
- Further research is needed to understand the drivers of ED use in this population.
- Opportunities exist to divert non-urgent ED care to outpatient and community-based settings.
Objective:
Reducing emergency department (ED) use in children with complex chronic conditions (CCC) is a national health system priority. Emergency department visits with minimal clinical intervention may be the most avoidable. We assessed characteristics associated with experiencing such a low-resource ED visit among children with a CCC.
Methods:
A retrospective study of 271,806 ED visits between 2014 and 2017 among patients with a CCC in the Pediatric Health Information System database was performed. The main outcome was a low-resource ED visit, where no medications, laboratory, procedures, or diagnostic tests were administered and the patient was not admitted to the hospital. χ2 Tests and generalized linear models were used to assess bivariable and multivariable relationships of patients' demographic, clinical, and health service characteristics with the likelihood of a low- versus higher-resource ED visit.
Results:
Sixteen percent (n = 44,111) of ED visits among children with CCCs were low-resource. In multivariable analysis, the highest odds of experiencing a low- versus higher-resource ED visit occurred in patients aged 0 year (vs 16+ years; odds ratio [OR], 3.9 [95% confidence interval {CI}, 3.7-4.1]), living <5 (vs 20+) miles from the ED (OR, 1.7 [95% CI, 1.7-1.8]), and who presented to the ED in the day and evening versus overnight (1.5 [95% CI, 1.4-1.5]).
Conclusions:
Infant age, living close to the ED, and day/evening-time visits were associated with the greatest likelihood of experiencing a low-resource ED visit in children with CCCs. Further investigation is needed to assess key drivers for ED use in these children and identify opportunities for diversion of ED care to outpatient and community settings.
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