Access to Care for Children With Fractures

Iobst, Christopher; King, Wesley F.; Baitner, Avi C.; Tidwell, Michael; Swirsky, Stephen; Skaggs, David L.

doi:10.1097/bpo.0b013e3181d413c5

Cited by 51 publications

(47 citation statements)

References 8 publications

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“…Previous work has demonstrated that barriers exist to obtaining timely outpatient follow-up for children with both public 1,6 and private 2 insurance after sustaining a fracture. Our findings substantiate those reported previously, as insurance type contributed significantly to the likelihood of revisit.…”

Section: Discussionmentioning

confidence: 99%

“…However, disparities in health care and specifically in orthopaedic care persist despite increases in the number of children insured. It is difficult to obtain a timely pediatric orthopaedic follow-up visit, regardless of insurance status 1,2,6 . Iobst has suggested that orthopaedic surgeons practicing in relatively litigious communities may be unwilling to see pediatric patients due to fear of litigation 2 .…”

Section: Discussionmentioning

confidence: 99%

“…It is difficult to obtain a timely pediatric orthopaedic follow-up visit, regardless of insurance status 1,2,6 . Iobst has suggested that orthopaedic surgeons practicing in relatively litigious communities may be unwilling to see pediatric patients due to fear of litigation 2 . When this risk of litigation is coupled with poor reimbursement for pediatric fracture care 1 , substantial challenges can arise in obtaining timely follow-up specialty care for children.…”

Section: Discussionmentioning

confidence: 99%

“…Prior research has demonstrated difficulty in obtaining initial outpatient visits after being seen in the emergency department (ED) for pediatric patients with both private and government-funded insurance plans 1,2 . This is despite policy-based efforts, such as the Children's Health Insurance Plan 3 , to expand health insurance coverage for American children.…”

Section: Introductionmentioning

confidence: 99%

“…Sturm and colleagues investigated the influence of insurance status on pediatric revisits at a single large metropolitan medical center 5 , while Skaggs 1,6 and Iobst 2 have used survey methods to demonstrate an inability to obtain follow-up for patients with pediatric fractures. In the current investigation, we calculated the incidence of return visits within 8 weeks to any in-state ED for the same fracture diagnosis using population-based data from a statewide data collection system.…”

Section: Introductionmentioning

confidence: 99%

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Socioeconomic Factors Are Associated With Frequency of Repeat Emergency Department Visits for Pediatric Closed Fractures

Lyman

Hương

et al. 2014

Journal of Pediatric Orthopaedics

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Background Previous research has demonstrated both greater difficulty in obtaining follow-up appointments and increased likelihood of return visits to the emergency department (ED) for patients with government-funded insurance plans. The purpose of the current study is to determine whether socioeconomic factors, such as race and insurance type, are associated with the frequency of repeat ED visits in pediatric patients with closed fractures. Methods A review of ED visit data over a 2-year period from a statewide hospital discharge database in New York was conducted. Discharges for patients with a unique person identifier in the database age 17 and younger were examined for an ICD-9 diagnosis of closed upper or lower extremity fracture. Age, sex, race, and insurance type for patients with a return ED visit within 8 weeks for the same fracture diagnosis were compared to those without a return visit using standard univariate statistical tests and logistic regression analyses. Results Of the 68,236 visits reviewed, the revisit rate was 0.85%. Patients of non-white or unidentified race were significantly more likely to have a revisit than white patients (OR 1.27; p=0.006). Patients with government-funded insurance were significantly more likely to have a revisit than those without government-funded insurance (OR 1.55; p<0.001). Patients with private insurance were significantly less likely to have a revisit than those without private insurance (OR 0.72; p=0.001). Conclusions Our analysis revealed that non-white patients are more likely to return to the ED within 8 weeks for the same fracture diagnosis. Patients with government insurance are 55% more likely to have a revisit, while patients with private insurance are 28% less likely to have a revisit. Our results suggest that socioeconomic disparities exist in access to orthopaedic care for closed fractures in a pediatric population. Physicians and policy makers should be mindful of these health care disparities when striving to improve access to care among patients and resource utilization in the emergency department. Level of Evidence Prognostic Level II

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Socioeconomic Factors Are Associated With Frequency of Repeat Emergency Department Visits for Pediatric Closed Fractures

Lyman

Hương

et al. 2014

Journal of Pediatric Orthopaedics

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Academic Medical Centers and Equity in Specialty Care Access for Children

Bisgaier

Polsky

Rhodes

2012

Arch Pediatr Adolesc Med

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Low Vitamin D Levels in Children with Fractures: A Comparative Cohort Study

Fabricant

McLaren

et al. 2015

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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BackgroundThe currently accepted ranges for “normal” serum vitamin D have recently been challenged in adults on the basis that healthy bone metabolism requires higher levels of vitamin D than previously thought.PurposeThe purpose of this study was to evaluate whether a new “biologically based” classification based on 25(OH)vitamin D levels that invoke an endocrine biomarker response (<20 ng/mL for deficiency and <32 ng/mL for insufficiency) is more appropriate for children with fractures than historical criteria.MethodsSerum 25(OH)vitamin D levels were collected from 58 children with acute low-energy fractures from an outpatient orthopedic clinic from 2009 to 2012. These vitamin D levels were compared with a cohort of 103 children with chronic kidney disease (CKD) from an adjacent clinic, a condition with acknowledged low levels of vitamin D. Then, the prevalence of vitamin D sufficiency in the fracture cohort was evaluated and compared using both historical guidelines and newer biologically based criteria.Results25(OH)vitamin D levels in the fracture cohort did not differ from levels in the CKD cohort (27.5 vs. 24.6 ng/mL) indicating a similar distribution of vitamin D levels. This finding was consistent when controlling for significant covariables using linear regression analyses. In the fracture cohort, there was a discrepancy between historical and biologically based criteria in 64% of children.ConclusionsThe results of the current study suggest that fracture patients are more frequently vitamin D deficient than previously thought. This finding is more readily apparent when newer biologically based criteria for vitamin D sufficiency are used.Electronic supplementary materialThe online version of this article (doi:10.1007/s11420-015-9447-7) contains supplementary material, which is available to authorized users.

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Access to Care for Children With Fractures

Abstract: Level II.

Cited by 51 publications

References 8 publications

Socioeconomic Factors Are Associated With Frequency of Repeat Emergency Department Visits for Pediatric Closed Fractures

Socioeconomic Factors Are Associated With Frequency of Repeat Emergency Department Visits for Pediatric Closed Fractures

Academic Medical Centers and Equity in Specialty Care Access for Children

Low Vitamin D Levels in Children with Fractures: A Comparative Cohort Study

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