Rural-Urban Differences in Emergency Department Choice for Children With Medical Complexity, 2012-2017.

Area of Science:

• Pediatric Emergency Medicine
• Health Services Research
• Rural Health Disparities

Background:

• Children with medical complexity (CMC) often require specialized care, influencing their emergency department (ED) choices.
• Understanding ED utilization patterns for CMC, particularly differences by rurality, is crucial for healthcare planning.
• Previous research has not extensively explored ED bypass behaviors among CMC in rural versus urban settings.

Purpose of the Study:

• To describe rural-urban differences in ED care and bypass patterns for CMC.
• To examine the association between ED bypass and visit outcomes, including transfer, admission, and mortality.
• To identify factors influencing ED bypass decisions for CMC.

Main Methods:

• Analysis of 2012-2017 all-payer claims data from Colorado, Massachusetts, and New Hampshire.
• Definition of bypass as a driving time difference of ≥5 minutes to the closest ED.
• Logistic regression models used to identify factors associated with bypass and its impact on outcomes.

Main Results:

• A total of 82,747 CMC accounted for 284,374 ED visits.
• Rural CMC were less likely to bypass their closest ED (26.9%) compared to urban CMC (43.7%).
• ED bypass was linked to increased odds of hospital admission (OR=2.19) but not interfacility transfer or mortality. Chronic conditions increased bypass odds, while Medicaid coverage decreased them.

Conclusions:

• Significant rural-urban disparities exist in ED care-seeking behaviors and bypass patterns for CMC.
• ED bypass for CMC is associated with higher admission rates, highlighting potential care coordination challenges.
• Findings can inform targeted interventions to improve ED access and care for CMC, considering geographic and socioeconomic factors.