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Acute care utilization for ambulatory care-sensitive conditions among publicly insured children
Daniel J Shapiro1, Matt Hall2, Sriram Ramgopal3
1Division of Pediatric Emergency Medicine, University of California, San Francisco, San Francisco, California, USA.
Insights
Over a quarter of ambulatory care-sensitive condition (ACSC) encounters for children initially go to acute care. Weekend visits and capitated insurance increase this likelihood, suggesting a need for expanded primary care access.
Area of Science:
- Pediatric Healthcare Utilization
- Ambulatory Care-Sensitive Conditions (ACSCs)
- Health Services Research
Background:
- Limited data exists on acute care use for ambulatory care-sensitive conditions (ACSCs) in non-hospitalized children.
- Understanding care-seeking patterns for ACSCs is crucial for optimizing pediatric healthcare delivery.
- Shifting care for common ACSCs to primary care settings can improve health outcomes and reduce costs.
Purpose of the Study:
- To describe patterns of initial healthcare utilization for pediatric ambulatory care-sensitive conditions (ACSCs).
- To identify factors associated with seeking initial care in acute care settings versus office-based settings.
- To inform strategies for directing ACSC care towards the medical home model.
Main Methods:
- Retrospective analysis of pediatric encounters for ACSCs from 2017-2019.
- Utilized the IBM Watson MarketScan Medicaid database for insurance claims of Medicaid-insured children.
- Employed generalized estimating equations to identify associations between encounter characteristics and initial site of care (acute vs. office).
Main Results:
- 27.9% of over 7 million pediatric ACSC encounters initiated in acute care settings (emergency or urgent care).
- Urinary tract infections (52.0%) and pneumonia (44.6%) had the highest proportion of initial acute care visits.
- Weekend encounters (aOR 6.30) and capitated insurance (aOR 1.55) were significantly associated with higher odds of initial acute care utilization.
Conclusions:
- A significant proportion of ambulatory care-sensitive condition (ACSC) encounters for publicly insured children begin in acute care settings.
- Expanded primary care access, particularly during weekends, may help redirect ACSC care to the medical home.
- Findings highlight opportunities to improve primary care accessibility and reduce reliance on acute care for common pediatric conditions.
Background:
Although characteristics of preventable hospitalizations for ambulatory care-sensitive conditions (ACSCs) have been described, less is known about patterns of emergency and other acute care utilization for ACSCs among children who are not hospitalized. We sought to describe patterns of utilization for ACSCs according to the initial site of care and to determine characteristics associated with seeking initial care in an acute care setting rather than in an office. A better understanding of the sequence of health care utilization for ACSCs may inform efforts to shift care for these common conditions to the medical home.
Methods:
We performed a retrospective analysis of pediatric encounters for ACSCs between 2017 and 2019 using data from the IBM Watson MarketScan Medicaid database. The database includes insurance claims for Medicaid-insured children in 10 anonymized states. We assessed the initial sites of care for ACSC encounters, which were defined as either acute care settings (emergency or urgent care) or office-based settings. We used generalized estimating equations clustered on patient to identify associations between encounter characteristics and the initial site of care.
Results:
Among 7,128,515 encounters for ACSCs, acute care settings were the initial site of care in 27.9%. Diagnoses with the greatest proportion of episodes presenting to acute care settings were urinary tract infection (52.0% of episodes) and pneumonia (44.6%). Encounters on the weekend (adjusted odds ratio [aOR] 6.30, 95% confidence interval [CI] 6.27-6.34 compared with weekday) and among children with capitated insurance (aOR 1.55, 95% CI 1.54-1.56 compared with fee for service) were associated with increased odds of seeking care first in an acute care setting.
Conclusions:
Acute care settings are the initial sites of care for more than one in four encounters for ACSCs among publicly insured children. Expanded access to primary care on weekends may shift care for ACSCs to the medical home.
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