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Predictors of Pediatric Frequent Emergency Department Use Among 7.6 million Pediatric Patients in New York

  • Sophia C. Anyatonwu
    Affiliations
    Population Informatics Lab, School of Public Health (SC Anyatonwu, TV Giannouchos, DJ Washburn, RL Ohsfeldt, and HC Kum), Texas A&M University, College Station, Tex

    Department of Health Policy & Management, School of Public Health (SC Anyatonwu, DJ Washburn, RL Ohsfeldt, and HC Kum), Texas A&M University, College Station, Tex
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  • Theodoros V. Giannouchos
    Correspondence
    Address correspondence to Theodoros Giannouchos, Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, 915 Greene St, Columbia, SC
    Affiliations
    Population Informatics Lab, School of Public Health (SC Anyatonwu, TV Giannouchos, DJ Washburn, RL Ohsfeldt, and HC Kum), Texas A&M University, College Station, Tex

    Department of Health Services Policy & Management, Arnold School of Public Health (TV Giannouchos), University of South Carolina, Columbia, SC
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  • David J. Washburn
    Affiliations
    Population Informatics Lab, School of Public Health (SC Anyatonwu, TV Giannouchos, DJ Washburn, RL Ohsfeldt, and HC Kum), Texas A&M University, College Station, Tex

    Department of Health Policy & Management, School of Public Health (SC Anyatonwu, DJ Washburn, RL Ohsfeldt, and HC Kum), Texas A&M University, College Station, Tex
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  • Ricardo A. Quinonez
    Affiliations
    Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine (RA Quinonez), Texas Children's Hospital, Houston, Tex
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  • Robert L. Ohsfeldt
    Affiliations
    Population Informatics Lab, School of Public Health (SC Anyatonwu, TV Giannouchos, DJ Washburn, RL Ohsfeldt, and HC Kum), Texas A&M University, College Station, Tex

    Department of Health Policy & Management, School of Public Health (SC Anyatonwu, DJ Washburn, RL Ohsfeldt, and HC Kum), Texas A&M University, College Station, Tex
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  • Hye-Chung Kum
    Affiliations
    Population Informatics Lab, School of Public Health (SC Anyatonwu, TV Giannouchos, DJ Washburn, RL Ohsfeldt, and HC Kum), Texas A&M University, College Station, Tex

    Department of Health Policy & Management, School of Public Health (SC Anyatonwu, DJ Washburn, RL Ohsfeldt, and HC Kum), Texas A&M University, College Station, Tex
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Published:April 03, 2022DOI:https://doi.org/10.1016/j.acap.2022.03.016

      Abstract

      Objective

      This study examines the characteristics and factors associated with frequent emergency department (ED) utilization among the pediatric population.

      Methods

      We conducted a pooled cross-sectional secondary analysis using the Healthcare Cost and Utilization Project State Emergency and Inpatient Databases on ED visits to all hospitals in New York from 2011 to 2016 by patients aged 0 to 21. We used multivariable logistic and negative binomial regressions to investigate the predictors of multiple ED visits in the pediatric population.

      Results

      Overall, our study included 7.6 million pediatric patients who accounted for more than 12 million ED visits. Of those, 6.2% of patients were frequent ED users (≥4 visits/year), accounting for 20.8% of all ED visits (5.4 ED visits/year on average). The strongest predictors of frequent ED use were having at least one ED visit related to asthma (aOR = 8.37 [95% CI: 6.34–11.04]), mental health disorders (aOR = 9.67 [95% CI: 8.60–10.89]), or multiple comorbidities compared to none. Larger shares of ED visits for not-emergent conditions were also associated with frequent ED use (aOR = 6.63 [95% CI = 5.08–8.65]). Being covered by Medicaid compared to private (aOR = 0.45 [95% CI: 0.42–0.47]) or no insurance (aOR = 0.41 [95% CI: 0.38–0.44]) were further associated with frequent ED use. The results from the negative binomial regression yielded consistent findings.

      Conclusions

      Pediatric patients who exhibit increased ED use are more medically complex and have increased healthcare needs that are inextricably tied to social determinants of health. Better integrated health systems should emphasize connecting vulnerable patients to appropriate social and primary care services outside of emergency settings

      Keywords

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