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

被引：17

作者：

Peltz, Alon ^{[1
,3
]}

Samuels-Kalow, Margaret E. ^{[4
]}

Rodean, Jonathan ^{[5
]}

Hall, Matthew ^{[5
]}

Alpern, Elizabeth R. ^{[6
]}

Aronson, Paul L. ^{[2
]}

Berry, Jay G. ^{[7
]}

Shaw, Kathy N. ^{[9
,10
,11
]}

Morse, Rustin B. ^{[12
,13
]}

Freedman, Stephen B. ^{[14
,15
]}

Cohen, Eyal ^{[16
]}

Simon, Harold K. ^{[17
,18
]}

Shah, Samir S. ^{[19
,20
]}

Katsogridakis, Yiannis ^{[6
]}

Neuman, Mark I. ^{[8
]}

机构：

[1] Yale Sch Med, Robert Wood Johnson Fdn, Clin Scholars Program, 333 Cedar St,POB 208088, New Haven, CT 06520 USA

[2] Yale Sch Med, Dept Pediat & Emergency Med, Sect Pediat Emergency Med, New Haven, CT USA

[3] Boston Med Ctr, Dept Pediat, Boston, MA USA

[4] Massachusetts Gen Hosp, Dept Emergency Med, Boston, MA 02114 USA

[5] Childrens Hosp Assoc, Lenexa, KS USA

[6] Northwestern Univ, Ann & Robert H Lurie Childrens Hosp Chicago, Feinberg Sch Med, Div Emergency Med, Chicago, IL 60611 USA

[7] Harvard Univ, Boston Childrens Hosp, Harvard Med Sch, Dept Med,Div Gen Pediat, Boston, MA 02115 USA

[8] Harvard Univ, Boston Childrens Hosp, Harvard Med Sch, Dept Med,Div Emergency Med, Boston, MA 02115 USA

[9] Univ Penn, Dept Pediat, Perelman Sch Med, Philadelphia, PA 19104 USA

[10] Univ Penn, Dept Emergency Med, Perelman Sch Med, Philadelphia, PA 19104 USA

[11] Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA

[12] Univ Texas Southwestern, Childrens Hlth Syst Texas, Dallas, TX USA

[13] Univ Texas Southwestern, Dept Pediat, Dallas, TX USA

[14] Univ Calgary, Alberta Childrens Hosp, Res Inst, Sect Pediat Emergency Med,Dept Pediat, Calgary, AB, Canada

[15] Univ Calgary, Alberta Childrens Hosp, Res Inst, Sect Gastroenterol,Dept Pediat, Calgary, AB, Canada

[16] Univ Toronto, Hosp Sick Children, Dept Pediat, Div Pediat Med, Toronto, ON, Canada

[17] Emory Univ, Sch Med, Dept Pediat & Emergency Med, Div Emergency Med, Atlanta, GA USA

[18] Childrens Healthcare Atlanta, Atlanta, GA USA

[19] Cincinnati Childrens Hosp Med Ctr, Dept Pediat, Div Hosp Med, Cincinnati, OH 45229 USA

[20] Cincinnati Childrens Hosp Med Ctr, Dept Pediat, Div Infect Dis, Cincinnati, OH 45229 USA

来源：

PEDIATRICS | 2017年 / 140卷 / 03期

基金：

美国国家卫生研究院;

关键词：

PRIMARY-CARE; VISITS; COST; PREDICTORS; RECURRENT; SERVICES; TRENDS; IMPACT; RETURN; STATE;

D O I：

10.1542/peds.2017-0962

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

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 20132014 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.

引用

页数：8

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