TY - JOUR
T1 - Characteristics of recurrent utilization in pediatric emergency departments
AU - Neuman, Mark I.
AU - Alpern, Elizabeth R.
AU - Hall, Matt
AU - Kharbanda, Anupam B.
AU - Shah, Samir S.
AU - Freedman, Stephen B.
AU - Aronson, Paul L.
AU - Florin, Todd A.
AU - Mistry, Rakesh D.
AU - Berry, Jay G.
N1 - Publisher Copyright:
© 2014 by the American Academy of Pediatrics.
PY - 2014
Y1 - 2014
N2 - 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.
AB - 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.
KW - Emergency department
KW - Frequency
KW - Utilization
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U2 - 10.1542/peds.2014-1362
DO - 10.1542/peds.2014-1362
M3 - Article
C2 - 25225134
AN - SCOPUS:84925547655
SN - 0031-4005
VL - 134
SP - e1025-e1031
JO - Pediatrics
JF - Pediatrics
IS - 4
ER -