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Pediatrics. 2017 Sep;140(3). pii: e20170962. doi: 10.1542/peds.2017-0962. Epub 2017 Aug 1.

Characteristics of Children Enrolled in Medicaid With High-Frequency Emergency Department Use.

Author information

1
Robert Wood Johnson Foundation Clinical Scholars Program and alon.peltz@yale.edu.
2
Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.
3
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
4
Children's Hospital Association, Lenexa, Kansas.
5
Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
6
Section of Pediatric Emergency Medicine, Department of Pediatrics and of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
7
Divisions of General Pediatrics and.
8
Departments of Pediatrics and.
9
Emergency Medicine, Perelman School of Medicine, University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
10
Children's Health System of Texas, and Department of Pediatrics, University of Texas Southwestern, Dallas, Texas.
11
Sections of Pediatric Emergency Medicine and.
12
Gastroenterology, Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
13
Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
14
Division of Emergency Medicine, Department of Pediatrics and Emergency Medicine, School of Medicine, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia; and.
15
Divisions of Hospital Medicine and.
16
Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
17
Emergency Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts.

Abstract

BACKGROUND AND OBJECTIVES:

Some children repeatedly use the emergency department (ED) at high levels. Among Medicaid-insured children with high-frequency ED use in 1 year, we sought to describe the characteristics of children who sustain high-frequency ED use over the following 2 years.

METHODS:

Retrospective longitudinal cohort study of 470 449 Medicaid-insured children appearing in the MarketScan Medicaid database, aged 1-16 years, with ≥1 ED discharges in 2012. Children with high ED use in 2012 (≥4 ED discharges) were followed through 2014 to identify characteristics associated with sustained high ED use (≥8 ED discharges in 2013-2014 combined). A generalized linear model was used to identify patient characteristics associated with sustained high ED use.

RESULTS:

A total of 39 945 children (8.5%) experienced high ED use in 2012, accounting for 25% of total ED visits in 2012. Sixteen percent of these children experienced sustained high ED use in the following 2 years. Adolescents (adjusted odds ratio [aOR]: 1.4 [95% confidence interval: 1.3-1.5]), disabled children (aOR: 1.3 [95% confidence interval: 1.1-1.5]), and children with 3 or more chronic conditions (aOR: 2.1, [95% confidence interval: 1.9-2.3]) experienced the highest likelihood for sustaining high ED use.

CONCLUSIONS:

One in 6 Medicaid-insured children with high ED use in a single year experienced sustained high levels of ED use over the next 2 years. Adolescents and individuals with multiple chronic conditions were most likely to have sustained high rates of ED use. Targeted interventions may be indicated to help reduce ED use among children at high risk.

PMID:
28765381
PMCID:
PMC5574719
DOI:
10.1542/peds.2017-0962
[Indexed for MEDLINE]
Free PMC Article

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