Characteristics of recurrent utilization in pediatric emergency departments

Mark I. Neuman*, Elizabeth R. Alpern, Matt Hall, Anupam B. Kharbanda, Samir S. Shah, Stephen B. Freedman, Paul L. Aronson, Todd A. Florin, Rakesh D. Mistry, Jay G. Berry

*Corresponding author for this work

Research output: Contribution to journalArticle

36 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)e1025-e1031
JournalPediatrics
Volume134
Issue number4
DOIs
StatePublished - Jan 1 2014

Fingerprint

Hospital Emergency Service
Pediatrics
Emergency Medical Services
Odds Ratio
Confidence Intervals
Costs and Cost Analysis
Hospital Laboratories
Ibuprofen
Acetaminophen
Quality Improvement
Retrospective Studies

Keywords

  • Emergency department
  • Frequency
  • Utilization

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Neuman, M. I., Alpern, E. R., Hall, M., Kharbanda, A. B., Shah, S. S., Freedman, S. B., ... Berry, J. G. (2014). Characteristics of recurrent utilization in pediatric emergency departments. Pediatrics, 134(4), e1025-e1031. https://doi.org/10.1542/peds.2014-1362
Neuman, Mark I. ; Alpern, Elizabeth R. ; Hall, Matt ; Kharbanda, Anupam B. ; Shah, Samir S. ; Freedman, Stephen B. ; Aronson, Paul L. ; Florin, Todd A. ; Mistry, Rakesh D. ; Berry, Jay G. / Characteristics of recurrent utilization in pediatric emergency departments. In: Pediatrics. 2014 ; Vol. 134, No. 4. pp. e1025-e1031.
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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.",
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Neuman, MI, Alpern, ER, Hall, M, Kharbanda, AB, Shah, SS, Freedman, SB, Aronson, PL, Florin, TA, Mistry, RD & Berry, JG 2014, 'Characteristics of recurrent utilization in pediatric emergency departments', Pediatrics, vol. 134, no. 4, pp. e1025-e1031. https://doi.org/10.1542/peds.2014-1362

Characteristics of recurrent utilization in pediatric emergency departments. / Neuman, Mark I.; Alpern, Elizabeth R.; Hall, Matt; Kharbanda, Anupam B.; Shah, Samir S.; Freedman, Stephen B.; Aronson, Paul L.; Florin, Todd A.; Mistry, Rakesh D.; Berry, Jay G.

In: Pediatrics, Vol. 134, No. 4, 01.01.2014, p. e1025-e1031.

Research output: Contribution to journalArticle

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AU - Neuman, Mark I.

AU - Alpern, Elizabeth R.

AU - Hall, Matt

AU - Kharbanda, Anupam B.

AU - Shah, Samir S.

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AU - Aronson, Paul L.

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AU - Mistry, Rakesh D.

AU - Berry, Jay G.

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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.

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Neuman MI, Alpern ER, Hall M, Kharbanda AB, Shah SS, Freedman SB et al. Characteristics of recurrent utilization in pediatric emergency departments. Pediatrics. 2014 Jan 1;134(4):e1025-e1031. https://doi.org/10.1542/peds.2014-1362