Predicting Frequent Emergency Department Use by Pediatric Medicaid Patients

Abstract

The objective of this study was to determine the patient characteristics and health care utilization patterns that predict frequent emergency department (ED) use (≥4 visits per year) over time to assist health care organizations in targeting patients for care management. This was a retrospective, population-based study of 13,265 Medicaid children aged 0-20 years who were attributed to a single pediatric accountable care organization for at least 2 consecutive years between June 2012 and May 2015. Year-to-year persistence as a frequent ED user was 36.3% (95% confidence interval [CI]: 33.4 to 38.4), which does not support the notion that once a frequent user, always a frequent user. Hence, interventions to reduce frequent ED use may appear to be effective when ED use would have regressed toward the mean without any intervention. At an individual patient level, predictability of frequent ED use was 0.437 (95% CI: 0.358 to 0.485) across frequent ED users of all ages compared with 0.723 (95% CI: 0.435 to 0.824) for those aged <1 year. Accordingly, this latter group may be a better target for interventions than frequent ED users generally.

Pediatric Emergency Department Utilization and Reliance by Insurance Coverage in the United States

“…In agreement with previous analyses using 2000 to 2002 MEPS data, children with public insurance were more likely to have two or more ED visits and high EDR than children with private insurance . Contrary to findings from studies conducted in large, free‐standing children's hospitals, only 2.1% of children in the MEPS sample who visited the ED in the past year had four or more ED visits . Our findings indicate that publicly insured children are more likely to have visited the ED in the study year and to be reliant on the ED for health care.…”

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

“…Children with high ED use were defined as having 4 or more ED visits in 2012 (a threshold we selected on the basis of use in multiple previous studies). 1,2,4 We then measured the number of ED visits each child experienced in 2013 and 2014. We characterized the reasons for each ED visit using the diagnosis grouping system, a classification system developed specifically for categorizing the reasons for pediatric ED visits on the basis of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) billing codes.…”

“…1 -5 In previous studies, researchers have demonstrated that children with 4 or more ED visits in a single year account for between 13% and 42% of all ED use at pediatric EDs. 1,2,4 Medicaid-insured children often visit the ED at higher rates than privately insured children. 1, 6 -9 The reasons cited for higher ED use among Medicaid enrollees include higher burdens of certain chronic conditions and worse access to timely primary 10 and preventative care.…”

“…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.…”

Constipation-Related Emergency Department Use, and Associated Office Visits and Payments Among Commercially Insured Children

“…Many studies have identified patient characteristics that are associated with frequent pediatric ED visits including chronic disease, minority race, social determinants, age (particularly younger than 1 year), and public insurance. 12–14 Potential etiologies have included limited clinic office hours, increased clinic wait times, and lack of an identified usual source of care. 15 Parents with low health literacy were inclined to overestimate severity of illness and seek care sooner and visit a clinic only when an appointment is available within hours.…”