Impact of Chronic Conditions on Emergency Department Visits of Children Using Medicaid

被引：36

作者：

Berry, Jay G. ^{[1
]}

Rodean, Jonathan ^{[2
]}

Hall, Matthew ^{[2
]}

Alpern, Elizabeth R. ^{[3
]}

Aronson, Paul L. ^{[4
,5
]}

Freedman, Stephen B. ^{[6
,7
,8
]}

Brousseau, David C. ^{[9
]}

Shah, Samir S. ^{[10
,11
]}

Simon, Harold K. ^{[12
,13
]}

Cohen, Eyal ^{[14
]}

Marin, Jennifer R. ^{[15
,16
]}

Morse, Rustin B. ^{[17
,18
]}

O'Neill, Margaret ^{[1
]}

Neuman, Mark I. ^{[19
]}

机构：

[1] Harvard Med Sch, Boston Childrens Hosp, Dept Med, Div Gen Pediat, 300 Longwood Ave, Boston, MA 02115 USA

[2] Childrens Hosp Assoc, Overland Pk, KS USA

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

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

[5] Yale Sch Med, Dept Emergency Med, New Haven, CT USA

[6] Univ Calgary, Alberta Childrens Hosp, Dept Pediat, Sect Pediat Emergency Med, Calgary, AB, Canada

[7] Univ Calgary, Alberta Childrens Hosp, Dept Pediat, Sect Gastroenterol, Calgary, AB, Canada

[8] Univ Calgary, Res Inst, Calgary, AB, Canada

[9] Med Coll Wisconsin, Childrens Hosp Wisconsin, Dept Pediat, Div Emergency Med, Milwaukee, WI 53226 USA

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

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

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

[13] Childrens Healthcare Atlanta, Atlanta, GA USA

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

[15] Univ Pittsburgh, Sch Med, Dept Pediat, Pittsburgh, PA 15261 USA

[16] Univ Pittsburgh, Sch Med, Dept Emergency Med, Pittsburgh, PA USA

[17] Childrens Hlth Syst Texas, Dallas, TX USA

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

[19] Harvard Med Sch, Boston Childrens Hosp, Div Emergency Med, 300 Longwood Ave, Boston, MA 02115 USA

来源：

JOURNAL OF PEDIATRICS | 2017年 / 182卷

基金：

美国医疗保健研究与质量局;

关键词：

COMPLEX CHRONIC CONDITIONS; SICKLE-CELL-DISEASE; PRIMARY-CARE; TRIPLE AIM; DEVELOPMENTAL-DISABILITIES; HOSPITAL UTILIZATION; FREQUENT USERS; MENTAL-HEALTH; QUALITY; RECURRENT;

D O I：

10.1016/j.jpeds.2016.11.054

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

Objective To assess the impact of chronic conditions on children's emergency department (ED) use. Study design Retrospective analysis of 1 850 027 ED visits in 2010 by 3 250 383 children ages 1-21 years continuously enrolled in Medicaid from 10 states included in the Truven Marketscan Medicaid Database. The main outcome was the annual ED visit rate not resulting in hospitalization per 1000 enrollees. We compared rates by enrollees' characteristics, including type and number of chronic conditions, and medical technology (eg, gastrostomy, tracheostomy), using Poisson regression. To assess chronic conditions, we used the Agency for Healthcare Research and Quality's Chronic Condition Indicator system, assigning chronic conditions with ED visit rates >= 75th percentile as having the "highest" visit rates. Results The overall annual ED visit rate was 569 per 1000 enrollees. As the number of the children's chronic conditions increased from 0 to >= 3, visit rates increased by 180% (from 376 to 1053 per 1000 enrollees, P <.001). Rates were 174% higher in children assisted with vs without medical technology (1546 vs 565, P <.001). Sickle cell anemia, epilepsy, and asthma were among the chronic conditions associated with the highest ED visit rates (all >= 1003 per 1000 enrollees). Conclusions The highest ED visit rates resulting in discharge to home occurred in children with multiple chronic conditions, technology assistance, and specific conditions such as sickle cell anemia. Future studies should assess the preventability of ED visits in these populations and identify opportunities for reducing their ED use.

引用

页码：267 / 274

页数：8

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