A Comparison of Ambulatory Care Sensitive Hospitalizations Among Children With and Without Autism Spectrum Disorder



      To compare the prevalence of hospitalizations for ambulatory care sensitive conditions (ACSC) in children with and without autism spectrum disorder (ASD) and to compare inpatient health care utilization (total charges and length of stay) for the same conditions in children with and without ASD.


      The 2009 Kids' Inpatient Database was used to examine hospitalizations for ACSC in children within 3 cohorts: those with ASD, those with chronic conditions (CC) without ASD, and those with no CC.


      The proportion of hospitalizations for ACSC in the ASD cohort was 55.9%, compared with 28.2% in the CC cohort and 22.9% in the no-CC cohort (P < .001). Hospitalized children with ASD were more likely to be admitted for a mental health condition, epilepsy, constipation, pneumonia, dehydration, vaccine-preventable diseases, underweight, and nutritional deficiencies compared with the no-CC cohort. Compared with the CC cohort, the ASD cohort was more likely to be admitted for mental health conditions, epilepsy, constipation, dehydration, and underweight. Hospitalized children with ASD admitted for mental health conditions had significantly higher total charges and longer LOS compared with the other 2 cohorts.


      The proportion of potentially preventable hospitalizations is higher in hospitalized children with ASD compared with children without ASD. These data underscore the need to improve outpatient care of children with ASD, especially in the areas of mental health care and seizure management. Future research should focus on understanding the reasons for increased inpatient health care utilization in children with ASD admitted for mental health conditions.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Agency for Healthcare Research and Quality. Ambulatory care sensitive conditions: age-standardized acute care hospitalization rate for conditions where appropriate ambulatory care prevents or reduces the need for admission to the hospital, per 100,000 population under age 175 years. Available at: Accessed July 10, 2015.

        • Lu S.
        • Kuo D.Z.
        Hospital charges of potentially preventable pediatric hospitalizations.
        Acad Pediatr. 2012; 12: 436-444
        • Tom J.O.
        • Mangione-Smith R.
        • Grossman D.C.
        • et al.
        Well-child care visits and risk of ambulatory care-sensitive hospitalizations.
        Am J Manage Care. 2013; 19: 354-360
        • Raphael J.L.
        • Mei M.
        • Brousseau D.C.
        • et al.
        Associations between quality of primary care and health care use among children with special health care needs.
        Arch Pediatr Adolesc Med. 2011; 165: 399-404
        • Johnson C.P.
        • Myers S.M.
        Identification and evaluation of children with autism spectrum disorders.
        Pediatrics. 2007; 120: 1183-1215
        • Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators, Centers for Disease Control and Prevention (CDC)
        Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2010.
        MMWR Surveill Summ. 2014; 63: 1-21
        • Kogan M.D.
        • Strickland B.B.
        • Blumberg S.J.
        • et al.
        A national profile of the health care experiences and family impact of autism spectrum disorder among children in the United States, 2005–2006.
        Pediatrics. 2008; 122: e1149-e1158
        • Cooley W.C.
        • McAllister J.W.
        • Sherrieb K.
        • et al.
        Improved outcomes associated with medical home implementation in pediatric primary care.
        Pediatrics. 2009; 124: 358-364
        • Zuckerman K.E.
        • Lindly O.J.
        • Bethell C.D.
        • et al.
        Family impacts among children with autism spectrum disorder: the role of health care quality.
        Acad Pediatr. 2014; 14: 398-407
        • Golnik A.
        • Ireland M.
        • Borowsky I.W.
        Medical homes for children with autism: a physician survey.
        Pediatrics. 2009; 123: 966-971
        • Carbone P.S.
        Moving From research to practice in the primary care of children with autism spectrum disorders.
        Acad Pediatr. 2013; 13: 390-399
        • Lokhandwala T.
        • Khanna R.
        • West-Strum D.
        Hospitalization burden among individuals with autism.
        J Autism Dev Disord. 2012; 42: 95-104
        • Parker J.D.
        • Schoendorf K.C.
        Variation in hospital discharges for ambulatory care–sensitive conditions among children.
        Pediatrics. 2000; 106: 942-948
        • Hardin L.C.
        • Hilbe J.M.
        Generalized Linear Models and Extensions.
        2nd ed. STATA Press, College Station, TX2007
        • Mosquera R.A.
        • Avritscher E.B.
        • Samuels C.L.
        • et al.
        Effect of an enhanced medical home on serious illness and cost of care among high-risk children with chronic illness: a randomized clinical trial.
        JAMA. 2014; 312: 2640-2648
        • Cheak-Zamora N.C.
        • Farmer J.E.
        The impact of the medical home on access to care for children with autism spectrum disorders.
        J Autism Dev Disord. 2015; 45: 636-644
        • Golnik A.
        • Scal P.
        • Wey A.
        • et al.
        Autism-specific primary care medical home intervention.
        J Autism Dev Disord. 2012; 42: 1087-1093
        • Weedon D.
        • Carbone P.
        • Bilder D.
        • et al.
        Building a person-centered medical home: lessons from a program for people with developmental disabilities.
        J Health Care Poor Underserved. 2012; 23: 1600-1608
        • Child and Adolescent Health Measurement Initiative
        National profile of children with special health care needs and autism spectrum disorders: key findings from the 2009/10 NS-CSHCN and 2011/12 NSCH.
        (Data Resource Center, supported by Cooperative Agreement 1-U59-MC06980-01 from the US Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Available at:) (Accessed July 10, 2015)
        • Chiri G.
        • Warfield M.E.
        Unmet need and problems accessing core health care services for children with autism spectrum disorder.
        Matern Child Health J. 2012; 16: 1081-1091
        • Carbone P.S.
        • Murphy N.A.
        • Norlin C.
        • et al.
        Parent and pediatrician perspectives regarding the primary care of children with autism spectrum disorders.
        J Autism Dev Disord. 2013; 43: 964-972
        • Antonelli R.C.
        • Stille C.J.
        • Antonelli D.M.
        Care coordination for children and youth with special health care needs: a descriptive, multisite study of activities, personnel costs, and outcomes.
        Pediatrics. 2008; 122: e209-e216
        • Orinstein A.J.
        • Helt M.
        • Troyb E.
        • et al.
        Intervention for optimal outcome in children and adolescents with a history of autism.
        J Dev Behav Pediatr. 2014; 35: 247-256
        • Hill A.P.
        • Zuckerman K.E.
        • Hagen A.D.
        • et al.
        Aggressive behavior problems in children with autism spectrum disorders: prevalence and correlates in a large clinical sample.
        Res Autism Spectrum Disord. 2014; 8: 1121-1133
        • Segers M.
        • Rawana J.
        What do we know about suicidality in autism spectrum disorders? A systematic review.
        Autism Res. 2014; 7: 507-521
        • Kalb L.G.
        • Stuart E.A.
        • Freedman B.
        • et al.
        Psychiatric-related emergency department visits among children with an autism spectrum disorder.
        Pediatr Emerg Care. 2012; 28: 1269-1276
        • Mahajan R.
        • Bernal M.P.
        • Panzer R.
        • et al.
        Clinical practice pathways for evaluation and medication choice for attention-deficit/hyperactivity disorder symptoms in autism spectrum disorders.
        Pediatrics. 2012; 130: S125-S138
        • Frye R.E.
        • Sreenivasula S.
        • Adams J.B.
        Traditional and non-traditional treatments for autism spectrum disorder with seizures: an on-line survey.
        BMC Pediatr. 2011; 11: 37
        • Williams P.G.
        • Dalrymple N.
        • Neal J.
        Eating habits of children with autism.
        Pediatr Nurs. 2000; 26: 259-264
        • Aldinger K.A.
        • Lane C.J.
        • Veenstra-VanderWeele J.
        • et al.
        Patterns of risk for multiple co-occurring medical conditions replicate across distinct cohorts of children with autism spectrum disorder.
        Autism Res. 2015 May 24;
        • Accardo J.A.
        • Malow B.A.
        Sleep, epilepsy, and autism.
        Epilepsy Behav. 2015; 47: 202-206
        • McElhanon B.O.
        • McCracken C.
        • Karpen S.
        • et al.
        Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis.
        Pediatrics. 2014; 133: 872-883
        • Furuta G.T.
        • Williams K.
        • Kooros K.
        • et al.
        Management of constipation in children and adolescents with autism spectrum disorders.
        Pediatrics. 2012; 130: S98-S105
        • Hyman S.L.
        • Stewart P.A.
        • Schmidt B.
        • et al.
        Nutrient intake from food in children with autism.
        Pediatrics. 2012; 130: S145-S153
        • Rosenberg R.E.
        • Law J.K.
        • Anderson C.
        • et al.
        Survey of vaccine beliefs and practices among families affected by autism spectrum disorders.
        Clin Pediatr. 2013; 52: 871-874
        • Centers for Disease Control and Prevention (CDC)
        Severe influenza among children and young adults with neurologic and neurodevelopmental conditions—Ohio, 2011.
        MMWR Morb Mortal Wkly Rep. 2012; 60: 1729-1733
        • Glanz J.M.
        • Wagner N.M.
        • Narwaney K.J.
        • et al.
        A mixed methods study of parental vaccine decision making and parent-provider trust.
        Acad Pediatr. 2013; 13: 481-488
        • American Academy of Pediatrics
        Caring for Children With Autism Spectrum Disorders: A Resource Toolkit for Clinicians.
        2nd ed. American Academy of Pediatrics, Elk Grove Village, IL2012
        • Muskat B.
        • Burnham Riosa P.
        • Nicholas D.B.
        • et al.
        Autism comes to the hospital: the experiences of patients with autism spectrum disorder, their parents and health-care providers at two Canadian paediatric hospitals.
        Autism. 2015; 19: 482-490
        • Burke J.P.
        • Jain A.
        • Yang W.
        • et al.
        Does a claims diagnosis of autism mean a true case?.
        Autism. 2014; 18: 321-330
        • Malow B.A.
        • Byars K.
        • Johnson K.
        • et al.
        A practice pathway for the identification, evaluation, and management of insomnia in children and adolescents with autism spectrum disorders.
        Pediatrics. 2012; 130: S106-S124
      2. Autism Speaks. Autism Votes—An Autism Speaks initiative. Available at: Accessed July 10, 2015.