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Clinical and Demographic Factors Linked to Low-Value Emergency Department Visits in Pediatric Patients With Spina
Peter Y Cai1,2, Erin R McNamara1,2, Hatim Thaker1,2
1Department of Urology, Boston Children's Hospital, Boston, Massachusetts.
Insights
Low-value emergency visits for pediatric spina bifida patients are linked to younger age, minority ethnicity, and public insurance. Identifying these factors can improve population health strategies for spina bifida care.
Area of Science:
- Pediatric Healthcare
- Population Health Management
- Health Services Research
Background:
- Emergency department (ED) visits for pediatric spina bifida patients represent a significant healthcare cost.
- Identifying "low-value" ED visits, defined as those without clinical or imaging charges, is crucial for optimizing care delivery and resource allocation.
- Understanding factors contributing to low-value ED visits can inform targeted interventions and population health strategies.
Purpose of the Study:
- To identify demographic and clinical factors associated with low-value emergency visits in pediatric patients with spina bifida.
- To compare the rate of low-value emergency visits in spina bifida patients to a control group with obstructive/reflux uropathy.
- To analyze the cost implications of low-value emergency visits within the spina bifida population.
Main Methods:
- Retrospective analysis of emergency department encounters from 2016-2023 using the Pediatric Health Information System.
- Inclusion of 22,672 ED visits for patients with spina bifida (under 18 years) and a control group with obstructive/reflux uropathy.
- Logistic regression modeling was used to determine the odds of low-value emergency visits, controlling for various patient and encounter characteristics.
Main Results:
- Pediatric spina bifida patients had a higher rate of low-value ED visits (20.7%) compared to controls (17.7%; P < .001).
- Low-value visits were significantly associated with younger age, Hispanic/Latino ethnicity, Black race, public insurance, and genitourinary diagnoses.
- These low-value visits accounted for 3.8% of total ED-related costs for spina bifida patients, with wide inter-hospital variation in odds (0.31 to 5.36).
Conclusions:
- Younger age, minority ethnicity, public insurance, and genitourinary diagnoses are key factors associated with increased low-value ED visits in pediatric spina bifida.
- Significant variation in low-value visit rates across hospitals suggests opportunities for best practice sharing and targeted quality improvement initiatives.
- These findings underscore the need for tailored population health strategies to reduce avoidable emergency care utilization in pediatric spina bifida.
Purpose:
Identifying factors associated with emergency visits that could be delivered at lower cost sites may help guide population health strategies for pediatric patients with spina bifida.
Materials And Methods:
Emergency department encounters (2016-2023) by patients with spina bifida (younger than 18 years) in the Pediatric Health Information System were identified. Absence of clinical and imaging charges was defined as low-value emergency visit. We used a control population of patients (younger than 18 years) with obstructive/reflux uropathy who presented for emergency department encounters (2016-2023). Mixed-effects (with repeated individual measurements as random effect) logistic regression was fitted to model odds of low-value emergency visit.
Results:
In total, we included 22,672 emergency visits by patients with spina bifida. Of these, 20.7% of emergency visits were low value vs 17.7% in controls (P < .001). Costs related to low-value emergency visits account for 3.8% of all costs for emergency visit-related encounters in patients with spina bifida. Low-value emergency visits were associated with younger age (odds ratio [OR], 1.05 [1.04-1.06] per year younger), Hispanic/Latino ethnicity (OR, 1.21 [1.06-1.39] compared with non-Hispanics), Black race (OR, 1.35 [1.16-1.58] compared with White), public insurance (OR, 1.14 [1.01-1.29] compared with private insurance), and genitourinary encounter diagnosis (OR, 1.16 [1.04-1.30]). Using a standard patient, we found that the odds of low-value emergency visit across hospitals ranged from 0.31 to 5.36.
Conclusions:
Younger age, Hispanic/Latino ethnicity, Black and other race, public insurance, and genitourinary encounter diagnosis were associated with higher odds of low-value emergency visits in pediatric patients with spina bifida. There was wide variation across hospitals, which warrants further investigation to elucidate best practices.
