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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References
- "What do people do if they don’t have insurance?”:ED-to-ED referrals.Acad Emerg Med. 2018; 25: 6-14
- Trends in the contribution of emergency departments to the provision of hospital-associated health care in the USA.Int J Health Serv. 2018; 48: 267-288
- Trends and characteristics of US emergency department visits, 1997-2007.JAMA. 2010; 304: 664-670
- Trends in emergency department visits, 2006-2014.HCUP Stat Brief. 2017; 227
- Trends in hospital emergency department visits by age and payer, 2006–2015.HCUP Stat Brief. 2018; 238
- Health, United States. 2017: With Special Feature on Mortality.National Center for Health Statistics, Hyattsville, MD2018
- Overview of Pediatric Emergency Department Visits, 2015.HCUP Stat Brief. 2018; 242
Rui P, Kang K, Ashman JJ. National Hospital Ambulatory Medical Care Survey: 2016 emergency department summary tables. 2016. Available at: https://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2016_ed_web_tables.pdf. Accessed May 15, 2022.
- Characteristics of recurrent utilization in pediatric emergency departments.Pediatrics. 2014; 134: e1025-e1031
- Characterizing pediatric high frequency users of California emergency departments.Am J Emerg Med. 2019; 37: 1699-1704
- Frequent pediatric emergency department use in infancy and early childhood.Pediatr Emerg Care. 2014; 30: 710-717
- Characteristics of children enrolled in Medicaid with high-frequency emergency department use.Pediatrics. 2017; 140e20170962
- Predicting low-resource-intensity emergency department visits in children.Acad Pediatr. 2018; 18: 297-304
- Pediatric emergency department utilization and reliance by insurance coverage in the United States.Acad Emerg Med. 2017; 24: 1483-1490
- Frequent emergency department use in the paediatric population: a systematic literature review.J Eval Clin Pract. 2020; 27: 193-203
- Maternal and child factors affecting high-volume pediatric emergency department use.Pediatr Emerg Care. 2006; 22: 301-308
- Characteristics of frequent pediatric emergency department users.Pediatr Emerg Care. 1995; 11: 340-346
- Revisiting the behavioral model and access to medical care: does it matter?.J Health Soc Behav. 1995; 36: 1-10
- Nonemergent emergency room utilization for an inner-city pediatric population.Pediatr Emerg Care. 2005; 21: 363-366
- Healthcare cost and utilization project (HCUP).HCUP State Emergency Department Databases (SEDD). Agency for Healthcare Research and Quality, Rockville, Md2009
- Healthcare cost and utilization project (HCUP).HCUP Clinical Classifications Software (CCS) for ICD-9-CM. Agency for Healthcare Research and Quality, Rockville, Md2006–2009
- HCUP State Inpatient Databases (SID).Agency for Healthcare Research and Quality, Rockville, Md2009
- Predictors of multiple emergency department utilization among frequent emergency department users in 3 states.Med Care. 2020; 58: 137-145
- Examining frequent emergency department use among children and adolescents with autism spectrum disorder.Autism. 2021; 25: 1382-1394
- Defining frequent use of an urban emergency department.Emerg Med J. 2007; 24: 398-401
- Defining "high-frequency” emergency department use: does one size fit all for urban and rural areas?.Can Fam Physician. 2017; 63: e395-e399
- A “Patch” to the NYU emergency department visit algorithm.Health Serv Res. 2017; 52: 1264-1276
- Committee on practice and ambulatory medicine. Age limit of pediatrics.Pediatrics. 2017; 140e20172151
- Characteristics of frequently attending children in hospital emergency departments: a systematic review.BMJ Open. 2021; 11e051409
- Characteristics and predictors of adult frequent emergency department users in the United States: a systematic literature review.J Eval Clin Pract. 2019; 25: 420-433
- Pediatric primary care relationships and non-urgent emergency department use in children.Acad Pediatr. 2021; 21: 900-906
- Emergency department-based care transitions for pediatric patients: a systematic review.Pediatrics. 2016; 138e20160969
- Planning for health care transitions: results from the 2005-2006 National Survey of Children with Special Health Care Needs.Pediatrics. 2009; 123: e145-e152
- Frequent users of US emergency departments: characteristics and opportunities for intervention.Emerg Med J. 2014; 31: 526-532
- National study of barriers to timely primary care and emergency department utilization among Medicaid beneficiaries.Ann Emerg Med. 2012; 60: 4-10
- Routine emergency department use for sick care by children in the United States.Pediatrics. 1996; 98: 28-34
- The role of race and ethnicity in the state children's health insurance program (SCHIP) in four states: are there baseline disparities, and what do they mean for SCHIP?.Pediatrics. 2003; 112: e521-e532
- Reduction in racial and ethnic disparities after enrollment in the State Children's Health Insurance Program.Pediatrics. 2005; 115
- Is greater continuity of care associated with less emergency department utilization?.Pediatrics. 1999; 103: 738-742
- Providing care for children in immigrant families.Pediatrics. 2019; 144e20192077
- Focusing on children's health: Community approaches to addressing health disparities: Workshop summary.National Academies Press, 2009
- Enriched medical home intervention using community health worker home visitation and ED use.Pediatrics. 2020; 139
Article Info
Publication History
Published online: April 03, 2022
Accepted:
March 23,
2022
Received:
September 20,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
The authors have no conflicts of interest relevant to this article to disclose.
Identification
Copyright
Copyright © 2022 by Academic Pediatric Association
