Measures of ED utilization in a national cohort of children
| Autor: | Erik R. Hoefgen, Michelle L. Macy, Troy Richardson, Katherine A. Auger, Annie Lintzenich Andrews, Bonnie T. Zima, Matthew Hall, Jeffrey D. Colvin, Jessica L. Bettenhausen, Samir S. Shah, John M. Neff |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Pediatrics medicine.medical_specialty Adolescent Population Logistic regression National cohort Cohort Studies Young Adult medicine Ambulatory Care Humans education Child Retrospective Studies education.field_of_study business.industry Health Policy Infant Retrospective cohort study Emergency department Patient Acceptance of Health Care United States Identified patient Logistic Models Child Preschool Ambulatory Chronic Disease Female business Emergency Service Hospital Medicaid |
| Zdroj: | The American journal of managed care. 26(6) |
| ISSN: | 1936-2692 |
| Popis: | Objectives Emergency department (ED) utilization is often used as an indicator of poor chronic disease control and/or poor quality of care. We sought to determine if 2 ED utilization measures identify clinically or demographically different populations of children. Study design Retrospective cohort study utilizing IBM Health/Truven MarketScan Medicaid data. Methods Children and adolescents were categorized based on the presence and complexity of chronic medical conditions using the 3M Clinical Risk Group system. Children and adolescents were categorized as high ED utilizers using 2 measures: (1) ED reliance (EDR) (number of ED visits / [number of ED visits + number of ambulatory visits]; EDR >0.33 = high utilizer) and (2) visit counts (≥3 ED visits = high utilizer). Logistic regression models identified patient factors associated with each of our outcome measures. Results A total of 5,438,541 children and adolescents were included; 65% were without chronic disease (WO-CD), 32% had noncomplex chronic disease (NC-CD), and 3% had complex chronic disease (C-CD). EDR identified 18% as frequent utilizers compared with 7% by the visit count measure. In the visit count model, children younger than 2 years and those classified as WO-CD and NC-CD were less likely to be identified as high utilizers. Conversely, in the EDR model, children and adolescents 2 years and older and those classified as WO-CD and NC-CD were more likely to be classified as high utilizers. Conclusions The ED utilization measures identify clinically and demographically different groups of patients. Future studies should consider the medical complexity of the population being studied before choosing the most appropriate measure to employ. |
| Databáze: | OpenAIRE |
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