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Annual Report on Health Care for Children and Youth in the United States: Focus on Injury-Related Emergency Department Utilization and Expenditures

  • Pamela L. Owens
    Correspondence
    Address correspondence to Pamela L. Owens, PhD, Agency for Healthcare, Research and Quality, 540 Gaither Rd, Rockville, Maryland 20850.
    Affiliations
    From the Agency for Healthcare, Research and Quality, Department of Health and Human Services, Rockville, Md (Dr Owens, Dr Berdahl, Dr Dougherty, and Mr Zodet); Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Mass (Dr McCormick); and Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio (Dr Simpson)
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  • Marc W. Zodet
    Affiliations
    From the Agency for Healthcare, Research and Quality, Department of Health and Human Services, Rockville, Md (Dr Owens, Dr Berdahl, Dr Dougherty, and Mr Zodet); Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Mass (Dr McCormick); and Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio (Dr Simpson)
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  • Terceira Berdahl
    Affiliations
    From the Agency for Healthcare, Research and Quality, Department of Health and Human Services, Rockville, Md (Dr Owens, Dr Berdahl, Dr Dougherty, and Mr Zodet); Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Mass (Dr McCormick); and Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio (Dr Simpson)
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  • Denise Dougherty
    Affiliations
    From the Agency for Healthcare, Research and Quality, Department of Health and Human Services, Rockville, Md (Dr Owens, Dr Berdahl, Dr Dougherty, and Mr Zodet); Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Mass (Dr McCormick); and Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio (Dr Simpson)
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  • Marie C. McCormick
    Affiliations
    From the Agency for Healthcare, Research and Quality, Department of Health and Human Services, Rockville, Md (Dr Owens, Dr Berdahl, Dr Dougherty, and Mr Zodet); Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Mass (Dr McCormick); and Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio (Dr Simpson)
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  • Lisa A. Simpson
    Affiliations
    From the Agency for Healthcare, Research and Quality, Department of Health and Human Services, Rockville, Md (Dr Owens, Dr Berdahl, Dr Dougherty, and Mr Zodet); Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Mass (Dr McCormick); and Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio (Dr Simpson)
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      Objective

      To examine state differences in children's utilization of injury-related emergency department (ED) care across 14 states, benchmarking aggregate state estimates against national expenditure estimates for outpatient injury-related ED care.

      Methods

      A retrospective analysis was performed using the 2003 State Emergency Department Databases and State Inpatient Databases from the Healthcare Cost and Utilization Project and data from the Medical Expenditure Panel Survey. Pediatric ED visits with any injury International Classification of Diseases Ninth Version Clinical Modification (ICD-9-CM) diagnosis code were selected. The Barell Injury Diagnosis Matrix, ICDMAP-90 software, and the Trauma Information Exchange Program data were used to classify injuries, produce injury severity scores, and examine utilization in trauma centers. Aggregate and state-specific descriptive analyses compared differences in patient and injury characteristics and admission status by age, severity of injury, and expected payer.

      Results

      Over 1.5 million or nearly one-third of ED visits were for pediatric injuries in the 14 states studied. Nationally, 5.4% of children had an injury-related ED visit, and approximately $2.3 billion was spent on outpatient injury-related ED visits in 2003. The pattern of injury-related ED visit care varied considerably by state. For example, injury-related ED visit rates ranged from 63.3 to 164.4 per 1000 children. Infants, adolescents, children from very low income communities, and children from nonmetropolitan and nonmicropolitan areas were more likely to have an injury-related ED visit than their peers. Although patient characteristics were fairly consistent across states, admission rates and expected source of payment for injury-related ED visits varied considerably by state. Hospital admission rates ranged from 1.5% to 4.4% of injury-related ED visits and expected payer estimates ranged from 37.1% to 71.0% of visits billed to private insurance, 17.9% to 47.0% billed to Medicaid, and 2.1% to 10.4% billed as uninsured.

      Conclusions

      This study suggests that injuries account for a significant portion of pediatric ED visits. There is substantial variation in ED use and hospital admissions for injured children across states and payers. This variation suggests that there are several opportunities for improvement in emergency care for children. To better understand the underlying reason for the variation, multivariate and hypothesis-driven research should focus on the nature and outcomes of injury-related ED care in the context of small area practice patterns and state programs, policies, and care system characteristics.

      Key Words

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