Hospital Admission and Emergency Department Utilization in an Infant Medicaid Population

Abstract

A B S T R A C T BACKGROUND AND OBJECTIVE:In the first year of life, the rate of rehospitalization for infants has been shown to be between 4.4% and 9.5%. Reducing avoidable health care utilization is a population health priority. The goal of this study was to identify maternal and infant factors associated with rehospitalization and emergency department (ED) utilization in a cohort of newborn Medicaid recipients. METHODS:A longitudinal database was created by linking mother-infant dyads giving birth at a regional perinatal referral center with Delaware state Medicaid data. Multivariable logistic regression and negative binomial regression were used to examine inpatient hospitalization and ED utilization within 6 months after birth. RESULTS:The study cohort included 4112 infants; 452 (11.0%) were rehospitalized, and 1680 (41%) used the CONCLUSIONS:In this newborn Medicaid population, multiple maternal factors (including age, race, and mental health diagnoses) were associated with health care utilization in the 6 months after initial hospital discharge. Our data provide potential risk factors for targeted intervention and suggest that maternal factors should be considered in identifying a population at risk for rehospitalization and ED utilization.

Characteristics of Children Enrolled in Medicaid With High-Frequency Emergency Department Use

“…To our knowledge, this is the first study in which a continuous, a All comparisons of the "1-3 visits" and "≥4 visits" groups were significant at P < .001 using bivariate statistics. As in our study, adolescents 30 -32 and young children 2,4,20 have been previously recognized as having particularly high levels of ED use. Adolescence may be a period of poor adherence to recommended treatment regimens for chronic conditions, such as asthma, and this may contribute to more frequent exacerbations and ED visits.…”

“…These findings suggest that there are characteristics inherent to the child (ie, chronic illness) and/or their caregivers (ie, younger and less experienced parents 35 ) that may contribute to some children being more likely to return to the ED as they grow older. 20 Children with chronic conditions (and in particular, children with multiple chronic conditions) were most likely to have sustained high levels of ED use. Chronically ill children typically have higher overall requirements for health care services in a year, and these requirements often extend to ED services as well.…”

“…41 -43 However, researchers in previous studies who examined the relationship between race and/ or ethnicity and frequency of ED use have often demonstrated conflicting results. 1,4,8,20,44,45 One key difference in our approach that separates it from other studies is that we were able to more comprehensively account for each child's existing conditions through tracking their health care claims 1 year before the index ED visit. Minority children may be more severely impacted by chronic illness and also may not be able to receive timely primary care services to help meet their needs.…”

“…18 The literature on the persistence of ED use among children who use the ED at high levels is sparse. Previous studies have been limited to evaluations of children receiving care within a single geographic region, 4 at children's hospitals or pediatric EDs, 1,2,19 or infants 20 and children with specific chronic condition (ie, sickle cell disease). 21 These studies did not examine longitudinal trends in ED use across multiple EDs in a continuous, geographically diverse cohort of Medicaid-insured children.…”

Identification of Caregiver-Reported Social Risk Factors in Hospitalized Children

“…32,33 Indeed, the hospitalization of any child may be a sign of overall poor health, inadequate access to preventive care, difficulty with disease management, and new health care costs. 34 Thus, a failure to screen for social risk in inpatient families during a time in which they are a "captive" audience, potentially available for both assessment and intervention, may be a lost opportunity to better understand the weight and scope of social risks on health outcomes.…”