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Acad Pediatr. 2020 Jan 2. pii: S1876-2859(19)30521-2. doi: 10.1016/j.acap.2019.12.011. [Epub ahead of print]

Differences in Frequency of Visits to Pediatric Primary Care Practices and Emergency Departments by Body Mass Index.

Author information

1
Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519-1315, USA. Electronic address: Olga.kovalerchik@yale.edu.
2
Department of Pediatrics, Section of Emergency Medicine, Yale University School of Medicine, 100 York Street, Suite 1F, New Haven, CT 06511-5664, USA; Department of Pediatrics, Section of General Pediatrics, Yale University School of Medicine, 333 Cedar St, PO Box 208064, New Haven, CT 06520-8064, USA. Electronic address: emily.powers@yale.edu.
3
Yale University School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA. Electronic address: margaret.holland@yale.edu.
4
Department of Pediatrics, Section of General Pediatrics, Yale University School of Medicine, 333 Cedar St, PO Box 208064, New Haven, CT 06520-8064, USA. Electronic address: mona.sharifi@yale.edu.
5
Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519-1315, USA; Department of Pediatrics, Section of Emergency Medicine, Yale University School of Medicine, 100 York Street, Suite 1F, New Haven, CT 06511-5664, USA. Electronic address: melissa.langhan@yale.edu.

Abstract

OBJECTIVES:

To examine differences in utilization across health care settings among children by body mass index (BMI) categories to help identify opportunities for interventions.

METHODS:

A retrospective study was conducted using one year of electronic health records following an index primary care visit for children 3-17 years old in 2016. Index visits occurred at >40 pediatric practices affiliated with a Northeastern health system. Using normal BMI as a reference group, we examined the extent to which children's BMI percentile categories were associated with primary care visits, emergency department (ED) visits, hospitalizations, and ED visit acuity. Age, sex, race/ethnicity, and insurance status were used as covariates.

RESULTS:

Of those with biologically plausible values for height and weight (n=30,352), the prevalences of overweight, obesity, and severe obesity were 16.3%, 12.4%, and 5.7%, respectively. Children outside of the normal BMI range made more primary care visits; however, relative patterns of ED utilization were not consistent. Children with obesity versus normal BMI were less likely to have ED visits of high acuity. Risk of hospitalization was higher among children with overweight or severe obesity.

CONCLUSIONS:

Children's BMI categories were associated with health care utilization, specifically primary care visits, ED visits, and hospitalizations. Further investigation is needed to explore the drivers of these differences in utilization, such as the impact of stigma and perceived weight bias on care-seeking patterns, and to examine the role of settings outside of primary care in pediatric weight management.

KEYWORDS:

health care utilization; pediatric obesity; pediatrics; public health

PMID:
31904438
DOI:
10.1016/j.acap.2019.12.011

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