"Narrowing the Gap"

Piehl, Mark; Clemens, Conrad J.; Joines, Jerry D.

doi:10.1001/archpedi.154.8.791

Cited by 100 publications

(13 citation statements)

References 14 publications

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“…For example, appropriate follow-up and anticipatory guidance during the newborn check-up may be particularly important in high-risk socio-demographic populations, and potentially result in reduced ED visits. (18) Considering the relatively large number of neonatal ED visits, the role of each of these three areas for intervention is worthy of further study.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Visits in the Neonatal Period in the United States

Lee¹,

Bardach²,

Maselli³

et al. 2014

Pediatric Emergency Care

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Objectives To estimate the incidence of emergency department (ED) visits in the neonatal period in a nationally representative sample and examine variation by race. Methods The National Hospital Ambulatory Medical Care Survey is a nationally representative survey of utilization of ambulatory care services including EDs. We studied all ED visits for patients < 28 days from 2003 to 2008. Using National Birth Certificate data, we calculated visit rates by race. ED visits were also characterized by age, insurance status, diagnosis category, region, and hospital type (safety-net vs. non-safety net). Results There was an average of 320,540 neonatal ED visits in the U.S. per year, with an estimated 7.6% of births visiting the ED within 28 days. Estimated rates of ED visits were highest among Non-Hispanic Blacks, with 14.4% (95% CI 10.0-19.2) of newborns having an ED visit in the neonatal period, compared with 6.7% (95% CI 4.9-7.2) for Whites and 7.7% (95% 5.7-9.8) for Hispanics. Hispanic and Black neonates were more likely to be seen in safety-net hospitals (75.8-78.2%) than White (57.1%) patients (p=0.004). Conclusions In this first nationally representative study of neonatal visits to the ED, visits were common, with the highest rates in Non-Hispanic Blacks. Hispanic and Black neonates were more commonly seen in safety-net hospitals. Reasons for high visit rates deserve further study in order to determine whether hospital discharge practices and/or access to primary care are contributing factors.

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Section: Discussionmentioning

confidence: 99%

Emergency Department Visits in the Neonatal Period in the United States

Lee¹,

Bardach²,

Maselli³

et al. 2014

Pediatric Emergency Care

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“…The results of these studies indicate possible higher and less efficient healthcare utilization among patients with LEP compared with patients who speak English well. Use of language congruent providers and interpreters has been shown to result in less cost for ED visits among children [ 23 ], while improved access and utilization of primary care services has been associated with less ED visits [ 5 , 24 , 25 ]. More data on overall inpatient health care utilization among patients with LEP are needed to help shape interventions within primary care practices and medical homes to improve health care utilization among these patients.…”

Section: Introductionmentioning

confidence: 99%

Emergency department and inpatient health care utilization among patients who require interpreter services

Njeru

Sauver

Jacobson

et al. 2015

BMC Health Serv Res

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BackgroundLimited English proficiency is associated with health disparities and suboptimal health outcomes. Although Limited English proficiency is a barrier to effective health care, its association with inpatient health care utilization is unclear. The aim of this study was to examine the association between patients with limited English proficiency, and emergency department visits and hospital admissions.MethodsWe compared emergency department visits and hospitalizations in 2012 between patients requiring interpreter services and age-matched English-proficient patients (who did not require interpreters), in a retrospective cohort study of adult patients actively empanelled to a large primary health care network in a medium-sized United States city (n = 3,784).ResultsPatients who required interpreter services had significantly more Emergency Department visits (841 vs 620; P ≤ .001) and hospitalizations (408 vs 343; P ≤ .001) than patients who did not require interpreter services. On regression analysis the risk of a first Emergency Department visit was 60 % higher for patients requiring interpreter services than those who did not (unadjusted hazard ratio [HR], 1.6; 95 % confidence interval (CI), 1.4-1.9; P < .05), while that of a first hospitalization was 50 % higher (unadjusted HR, 1.5; 95 % CI, 1.2-1.8; P < .05). These findings remained significant after adjusting for age, sex, medical complexity, residency and outpatient health care utilization.ConclusionsPatients who required interpreter services had higher rates of inpatient health care utilization compared with patients who did not require an interpreter. Further research is required to understand factors associated with this utilization and to develop sociolinguistically tailored interventions to facilitate appropriate health care provision for this population.

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“…Few reports have studied the effects of assigning an admission avoidance team,[1718] but we depend on providing highly qualified PED doctors.…”

Section: Discussionmentioning

confidence: 99%

Reduction of pediatric emergency hospital admissions by a change in pediatric emergency department policy

Alazmi

Elhassanien

2013

J Emerg Trauma Shock

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Background:Reduction in admissions is an important aim of emergency department working policy to overcome the problems of a shortage of inpatient beds, rising costs and exhausted resources. A new policy was instituted in the pediatric emergency department (PED) of a hospital in Kuwait with the following components: (1) assigning senior doctor staff (2) implementation of new disease management guidelines; and (3) maximizing the use of the pediatric emergency department observation unit.Objective:to evaluate the effect of change in our policy on the admission rate.Materials and Methods:The effects of this policy on reduction of admission rates for total pediatric admissions and for some selected common pediatric conditions were prospectively studied over a period of 3 years from institution of the policy and compared with the 3-year period before the policy was instituted.Results:There was a significant reduction in admission rates after institution of the new policy. The proportion of hospital admissions to PED observation unit cases was significantly reduced as a whole from 64.9% ± 5.1% to 33.2 ± 0.6% and also for the common pediatric problems studied.Conclusion:A multidisciplinary pediatric emergency department policy, using as much available evidence as possible, was successful in significantly reducing pediatric hospital admissions.

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"Narrowing the Gap"

Cited by 100 publications

References 14 publications

Emergency Department Visits in the Neonatal Period in the United States

Emergency Department Visits in the Neonatal Period in the United States

Emergency department and inpatient health care utilization among patients who require interpreter services

Reduction of pediatric emergency hospital admissions by a change in pediatric emergency department policy

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