Updated Diagnosis Grouping System for Pediatric Emergency Department Visits

Fant, Colleen; Marín, Jennifer R.; Ramgopal, Sriram; Simon, Norma-Jean; Richards, Rachel; Olsen, Cody S.; Alessandrini, Evaline A.

doi:10.1097/pec.0000000000002692

Cited by 10 publications

(4 citation statements)

References 9 publications

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“…We excluded discharges without a diagnosis given concerns for data integrity and because we sought to examine the association of discharge diagnosis with outpatient follow‐up. Patients with mental health, trauma, and dental primary diagnosis as determined by the diagnosis and grouping system (DGS) categorization were excluded because of the unique concerns in these subgroups 8 . Extensive prior work has characterized the unique challenges in obtaining adequate ambulatory care for children with mental health concerns 9,10 .…”

Section: Methodsmentioning

confidence: 99%

“…Given that ED visits may contain multiple claims and primary diagnoses, we followed a tiered approach to determine the ultimate primary diagnosis in the following order: physician placed diagnosis codes, facility codes, and codes not associated with either a facility or physician. We categorized primary ICD‐10 codes using the diagnosis subgroup from the DGS that was developed specifically for pediatric ED encounters 8 . The DGS is a consensus‐derived classification structure that uses the ICD diagnosis codes to group ED visits into clinically sensible and comprehensive categories.…”

Section: Methodsmentioning

confidence: 99%

“…Patients with mental health, trauma, and dental primary diagnosis as determined by the diagnosis and grouping system (DGS) categorization were excluded because of the unique concerns in these subgroups. 8 Extensive prior work has characterized the unique challenges in obtaining adequate ambulatory care for children with mental health concerns. 9,10 Similarly, children with traumatic or dental diagnoses have follow-up considerations that we considered to be outside the scope of this study.…”

Section: Eligibility Criteriamentioning

confidence: 99%

“…We categorized primary ICD-10 codes using the diagnosis subgroup from the DGS that was developed specifically for pediatric ED encounters. 8 The DGS is a consensus-derived classification structure that uses the ICD diagnosis codes to group ED visits into clinically sensible and comprehensive categories. It is composed of 21 major groups containing 77 subgroups, and includes a more granular list of diagnoses.…”

Section: Data Acquisitionmentioning

confidence: 99%

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Ambulatory follow‐up among publicly insured children discharged from the emergency department

Ramgopal

Rodean

Hall

et al. 2023

Academic Emergency Medicine

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Background While children discharged from the emergency department (ED) are frequently advised to follow up with ambulatory care providers, the extent to which this occurs is unknown. We sought to characterize the proportion of publicly insured children who have an ambulatory visit following ED discharge, identify factors associated with ambulatory follow‐up, and evaluate the association of ambulatory follow‐up with subsequent hospital‐based health care utilization. Methods We performed a cross‐sectional study of pediatric (<18 years) encounters during 2019 included in the IBM Watson Medicaid MarketScan claims database from seven U.S. states. Our primary outcome was an ambulatory follow‐up visit within 7 days of ED discharge. Secondary outcomes were 7‐day ED return visits and hospitalizations. Logistic regression and Cox proportional hazards were used for multivariable modeling. Results We included 1,408,406 index ED encounters (median age 5 years, IQR 2–10 years), for which a 7‐day ambulatory visit occurred in 280,602 (19.9%). Conditions with the highest proportion of 7‐day ambulatory follow‐up included seizures (36.4%); allergic, immunologic, and rheumatologic diseases (24.6%); other gastrointestinal diseases (24.5%); and fever (24.1%). Ambulatory follow‐up was associated with younger age, Hispanic ethnicity, weekend ED discharge, ambulatory encounters prior to the ED visit, and diagnostic testing performed during the ED encounter. Ambulatory follow‐up was inversely associated with Black race and ambulatory care–sensitive or complex chronic conditions. In Cox models, ambulatory follow‐up was associated with a higher hazard ratio (HR) of subsequent ED return (HR range 1.32–1.65) visit and hospitalization (HR range 3.10–4.03). Conclusions One‐fifth of children discharged from the ED have an ambulatory visit within 7 days, which varied by patient characteristics and diagnoses. Children with ambulatory follow‐up have a greater subsequent health care utilization, including subsequent ED visit and/or hospitalization. These findings identify the need to further research the role and costs associated with routine post‐ED visit follow‐up.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Eligibility Criteriamentioning

confidence: 99%

Section: Data Acquisitionmentioning

confidence: 99%

See 2 more Smart Citations

Ambulatory follow‐up among publicly insured children discharged from the emergency department

Ramgopal

Rodean

Hall

et al. 2023

Academic Emergency Medicine

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Health Care Utilization With Telemedicine and In-Person Visits in Pediatric Primary Care

Casey,

Huang,

Parry

et al. 2024

JAMA Health Forum

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ImportanceTelemedicine is an increasingly used yet understudied vehicle to deliver pediatric primary care. Evidence detailing downstream health care utilization after telemedicine visits is needed.ObjectiveTo compare pediatric primary care conducted via telemedicine (video or telephone) with in-person office visits with regard to physician medication prescribing and imaging and laboratory ordering and downstream follow-up office visits, emergency department (ED) visits, and hospitalizations.Design, Setting, and ParticipantsThis cohort study included all patients younger than 18 years who had scheduled primary care appointments with a pediatrician from January 1 to December 31, 2022, in the Kaiser Permanente Northern California health system, a large integrated health care delivery system offering in-person office visits, video visits, or telephone visits for pediatric primary care.ExposurePediatric primary care in-person visit, telephone visit, or video visit.Main Outcome and MeasuresRates of physician medication prescribing and imaging and laboratory ordering during an index telemedicine or office visit and rates of in-person office visits, ED visits, and hospitalizations within 7 days after the visit, adjusted for patient and clinical characteristics.ResultsOf 782 596 total appointments (51.1% male) among 438 638 patients, telemedicine was used for 332 153 visits (42.4%). After adjustment, there was more medication prescribing for in-person visits (39.8%) compared with video visits (29.5%; adjusted difference, −10.3%; 95% CI, −10.6% to −10.0%) or telephone visits (27.3%; adjusted difference, −12.5%; 95% CI, −12.5% to −12.7%). There was also more laboratory ordering for in-person visits (24.6%) compared with video visits (7.8%; adjusted difference, −16.8%; 95% CI, −17.0% to −16.6%) or telephone visits (8.5%; adjusted difference, −16.2%; 95% CI, −16.3% to −16.0%). There was more imaging ordering for in-person visits (8.5%) compared with video visits (4.0%; adjusted difference, −4.5%; 95% CI, −4.6% to −4.4%) and telephone visits (3.5%; adjusted difference, −5.0%; 95% CI, −5.1% to −4.9%). After adjustment, fewer in-person follow up visits occurred for index visits that were in-person (4.3%) compared with video (14.4%; adjusted difference, 10.1%; 95% CI, 9.9%-10.3%) or telephone (15.1%; adjusted difference, 10.8%; 95% CI, 10.7%-11.0%) visits. The rate of ED visits following an in-person visit was slightly lower (1.75%) compared with after video visits (2.04%; adjusted difference, 0.29%; 95% CI, 0.21%-0.38%) or telephone visits (2.00%; adjusted difference, 0.25%; 95% CI, 0.18%-0.33%). There was no statistically significant difference in the 7-day rate of hospitalizations.Conclusions and RelevanceIn this cohort study, telephone and video visits for pediatric primary care were associated with less prescribing and ordering than in-person visits. Telemedicine visits were associated with modestly higher rates of subsequent in-person visits and slightly higher rates of ED visits, and there was no difference in hospitalizations. Telemedicine appears to be a useful vehicle for health care delivery in the pediatric population, although it is not a universal substitute for in-person visits.

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Patient Photo Attachments and Telemedicine Visit Effectiveness: Is a Picture Worth a Thousand Words?

Huang,

Lieu,

Gopalan

et al. 2024

J GEN INTERN MED

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Updated Diagnosis Grouping System for Pediatric Emergency Department Visits

Cited by 10 publications

References 9 publications

Ambulatory follow‐up among publicly insured children discharged from the emergency department

Ambulatory follow‐up among publicly insured children discharged from the emergency department

Health Care Utilization With Telemedicine and In-Person Visits in Pediatric Primary Care

Patient Photo Attachments and Telemedicine Visit Effectiveness: Is a Picture Worth a Thousand Words?

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