Factors that Affect Nonurgent Emergency Department Visits in a Publicly Insured Pediatric Population: An Observational Study.

Abstract

Publicly insured children have high rates of nonurgent emergency department visits (LAVs). The factors that drive consumption of these services are unknown. Demographics, emergency department visits, hospitalizations, missed preventative care appointments, zip code, and asthma status as factors for LAVs were determined by univariate, multivariate, and classification/regression tree analysis. Subjects were publicly insured and received care between March 1 and December 31, 2011. A total of 4,387 children were identified; 856 (19.5%) had at least 1 nonurgent and 1,173 (26.7%) had at least 1 urgent emergency department visit; 526 (12%) missed ≥2 primary care appointments and 779 children had asthma. By univariate analysis, at least one high acuity emergency department visit, hospitalization during the study period, and asthma were directly associated with LAVs; age was inversely related. Multivariate and classification tree analyses identified children younger than 31.5 months with at least 1 high acuity emergency department visit as the highest risk group (0.807 visits per patient; 95% confidence interval: 0.699-0.916, p < .00001). Missed appointments, asthma status, hospitalizations, zip code of residence, and gender were not significant factors. Young age and at least one high acuity emergency department visit are associated with high rates of nonurgent emergency department use among publicly insured children.