Predictors of Pediatric Frequent Emergency Department Use Among 7.6 million Pediatric Patients in New York
Sophia C Anyatonwu1, Theodoros V Giannouchos2, David J Washburn1
1Population Informatics Lab, School of Public Health (SC Anyatonwu, TV Giannouchos, DJ Washburn, RL Ohsfeldt, and HC Kum), Texas A&M University, College Station, Tex; Department of Health Policy & Management, School of Public Health (SC Anyatonwu, DJ Washburn, RL Ohsfeldt, and HC Kum), Texas A&M University, College Station, Tex.
Insights
Frequent pediatric emergency department (ED) use is linked to complex medical needs and social determinants of health. Addressing these factors requires integrated care systems connecting vulnerable children to primary and social services.
Area of Science:
- Pediatric Health Services Research
- Healthcare Utilization Analysis
- Public Health Policy
Background:
- Frequent emergency department (ED) utilization is a significant concern in pediatric healthcare.
- Understanding the characteristics and predictors of high ED use is crucial for resource allocation and care improvement.
Purpose of the Study:
- To examine the factors associated with frequent emergency department (ED) utilization among pediatric patients.
- To identify predictors of multiple ED visits in the 0-21 age group.
Main Methods:
- Pooled cross-sectional secondary analysis of 7.6 million pediatric ED visits in New York (2011-2016).
- Utilized Healthcare Cost and Utilization Project (HCUP) databases.
- Employed multivariable logistic and negative binomial regressions to identify predictors of frequent ED use (≥4 visits/year).
Main Results:
- 6.2% of pediatric patients were frequent ED users, accounting for 20.8% of all ED visits.
- Key predictors of frequent ED use included asthma, mental health disorders, multiple comorbidities, and non-emergent visit reasons.
- Medicaid coverage was associated with lower odds of frequent ED use compared to private or no insurance.
Conclusions:
- Frequent pediatric ED users are often medically complex and face challenges tied to social determinants of health.
- Integrated health systems should focus on connecting vulnerable pediatric populations to appropriate social and primary care services.
- Reducing reliance on emergency departments for non-emergent pediatric needs requires enhanced community-based support systems.
Objective:
This study examines the characteristics and factors associated with frequent emergency department (ED) utilization among the pediatric population.
Methods:
We conducted a pooled cross-sectional secondary analysis using the Healthcare Cost and Utilization Project State Emergency and Inpatient Databases on ED visits to all hospitals in New York from 2011 to 2016 by patients aged 0 to 21. We used multivariable logistic and negative binomial regressions to investigate the predictors of multiple ED visits in the pediatric population.
Results:
Overall, our study included 7.6 million pediatric patients who accounted for more than 12 million ED visits. Of those, 6.2% of patients were frequent ED users (≥4 visits/year), accounting for 20.8% of all ED visits (5.4 ED visits/year on average). The strongest predictors of frequent ED use were having at least one ED visit related to asthma (aOR = 8.37 [95% CI: 6.34-11.04]), mental health disorders (aOR = 9.67 [95% CI: 8.60-10.89]), or multiple comorbidities compared to none. Larger shares of ED visits for not-emergent conditions were also associated with frequent ED use (aOR = 6.63 [95% CI = 5.08-8.65]). Being covered by Medicaid compared to private (aOR = 0.45 [95% CI: 0.42-0.47]) or no insurance (aOR = 0.41 [95% CI: 0.38-0.44]) were further associated with frequent ED use. The results from the negative binomial regression yielded consistent findings.
Conclusions:
Pediatric patients who exhibit increased ED use are more medically complex and have increased healthcare needs that are inextricably tied to social determinants of health. Better integrated health systems should emphasize connecting vulnerable patients to appropriate social and primary care services outside of emergency settings.
More Related Videos
07:31Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack
Published on: May 15, 2020
06:59A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Related Concept Videos
01:30Methods of Documentation VII: EMR
01:08The Availability Heuristic
01:25Statistical Methods for Analyzing Epidemiological Data
01:30Attention-Deficit/Hyperactivity Disorder
Diagnostic Criteria and Symptoms
To diagnose ADHD, symptoms must manifest before age 12 and be evident across multiple settings....
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
01:18Steps in Outbreak Investigation