Mark I Neuman1, Elizabeth R Alpern2, Matt Hall3, Anupam B Kharbanda4, Samir S Shah5, Stephen B Freedman6, Paul L Aronson7, Todd A Florin8, Rakesh D Mistry9, Jay G Berry10. 1. Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; mark.neuman@childrens.harvard.edu. 2. Division of Emergency Medicine, Lurie Children's Hospital, Center of Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois; 3. Children's Hospital Association, Overland Park, Kansas; 4. Division of Pediatric Emergency Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota; 5. Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; 6. Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital and Research Institute, University of Calgary, Calgary, Alberta, Canada; 7. Section of Emergency Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut; 8. Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio; 9. Section of Emergency Medicine, Department of Pediatrics, Children's Hospital of Colorado, Denver, Colorado; and. 10. Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND AND OBJECTIVE: Nationally, frequent utilizers of emergency departments (EDs) are targeted for quality improvement initiatives. The objective was to compare the characteristics and ED health services of children by their ED visit frequency. METHODS: A retrospective study in 1,896,547 children aged 0 to 18 years with 3,263,330 visits to 37 EDs in 2011. The number of ED visits per child within 365 days of their first visit was counted. Patient characteristics (age, chronic condition) and ED care (medications, testing [laboratory and radiographic], and hospital admission) were assessed. We evaluated the relationship between patient characteristics and ED health services received with multivariable regression. RESULTS: Children with ≥4 ED visits (8%) accounted for 24% of all visits and 31% ($1.4 billion) of all costs. As visit frequency increased from 1 to ≥4, the percentage of children aged <1 year increased (12.1% to 33.2%) and the percentage of children without a chronic condition decreased (81.9% to 45.6%) (P < .001 for both). Children with ≥4 ED visits had a higher percentage of visits without medication administration (aside from acetaminophen or ibuprofen), testing, or hospital admission when compared with children with 1 visit (35.4% vs 29.0%; P < .001). Children with ≥4 ED visits who were aged <1 year (odds ratio: 3.8; 95% confidence interval: 3.7-3.9) and who were without a chronic condition (odds ratio: 3.1; 95% confidence interval: 3.0-3.1) had the highest likelihood of experiencing this type of visit. CONCLUSIONS: With a disproportionate share of pediatric ED cost and utilization, frequent utilizers, especially infants without a chronic condition, are the least likely to need medications, testing, and hospital admission.
BACKGROUND AND OBJECTIVE: Nationally, frequent utilizers of emergency departments (EDs) are targeted for quality improvement initiatives. The objective was to compare the characteristics and ED health services of children by their ED visit frequency. METHODS: A retrospective study in 1,896,547 children aged 0 to 18 years with 3,263,330 visits to 37 EDs in 2011. The number of ED visits per child within 365 days of their first visit was counted. Patient characteristics (age, chronic condition) and ED care (medications, testing [laboratory and radiographic], and hospital admission) were assessed. We evaluated the relationship between patient characteristics and ED health services received with multivariable regression. RESULTS:Children with ≥4 ED visits (8%) accounted for 24% of all visits and 31% ($1.4 billion) of all costs. As visit frequency increased from 1 to ≥4, the percentage of children aged <1 year increased (12.1% to 33.2%) and the percentage of children without a chronic condition decreased (81.9% to 45.6%) (P < .001 for both). Children with ≥4 ED visits had a higher percentage of visits without medication administration (aside from acetaminophen or ibuprofen), testing, or hospital admission when compared with children with 1 visit (35.4% vs 29.0%; P < .001). Children with ≥4 ED visits who were aged <1 year (odds ratio: 3.8; 95% confidence interval: 3.7-3.9) and who were without a chronic condition (odds ratio: 3.1; 95% confidence interval: 3.0-3.1) had the highest likelihood of experiencing this type of visit. CONCLUSIONS: With a disproportionate share of pediatric ED cost and utilization, frequent utilizers, especially infants without a chronic condition, are the least likely to need medications, testing, and hospital admission.
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Authors: Alon Peltz; Margaret E Samuels-Kalow; Jonathan Rodean; Matthew Hall; Elizabeth R Alpern; Paul L Aronson; Jay G Berry; Kathy N Shaw; Rustin B Morse; Stephen B Freedman; Eyal Cohen; Harold K Simon; Samir S Shah; Yiannis Katsogridakis; Mark I Neuman Journal: Pediatrics Date: 2017-08-01 Impact factor: 7.124