Abstract
BackgroundA growing number of studies report increased concussion-related health care utilization in recent years, but factors impacting care-seeking behaviors among youth following a concussion are not well described. This study aimed to evaluate the influence of insurance type on the rate and type of initial concussion visits and the time from injury to the initial visit in youth.MethodsWe extracted and analyzed initial concussion-related medical visits for youth ages 10 to 17 from electronic health records. Patients must have visited Nationwide Children’s Hospital’s (NCH) concussion clinic at least once between 7/1/2012 and 12/31/2017. We evaluated the trends and patterns of initial concussion visits across the study period using regression analyses.ResultsOf 4955 unique concussion visits included, 60.1% were males, 80.5% were white, and 69.5% were paid by private insurance. Patients’ average age was 13.9 years (SD = 3.7). The rate of the initial concussion visits per 10,000 NCH visits was consistently higher in privately insured than publicly insured youth throughout the study period (P < .0001). Privately insured youth had greater odds of initial concussion visits to sports medicine clinics (AOR = 1.45, 95% CI = 1.20, 1.76) but lower odds of initial concussion visits to the ED/urgent care (AOR = 0.74, 95% CI = 0.60, 0.90) than publicly insured youth. Days from injury to initial concussion visit significantly decreased among both insurance types throughout the study (P < .0001), with a greater decrease observed in publicly insured than privately insured youth (P = .011).ConclusionsResults on the differences in the rate, type, and time of initial concussion-related visits may help inform more efficient care of concussion among youth with different types of insurance.
Highlights
A growing number of studies report increased concussion-related health care utilization in recent years, but factors impacting care-seeking behaviors among youth following a concussion are not well described
Using the electronic health record (EHR) system in a large pediatric healthcare network, we aimed to describe the influence of insurance type on the rate of the initial concussion visit, the type of initial visit sought, and the time from injury to the initial concussion visit
Of 4955 unique concussions included, 69.5% of initial concussion visits were paid by private insurance and 15.0% were paid by public insurance (Table 1)
Summary
A growing number of studies report increased concussion-related health care utilization in recent years, but factors impacting care-seeking behaviors among youth following a concussion are not well described. Radlicz et al BMC Public Health (2021) 21:1565 concussion; (2) medical clearance approved by a licensed health professional to return to play; and (3) education for parents, student-athletes, and coaches regarding concussion signs and symptoms [8] Evaluation of these laws show an increase in youth concussion rates and related healthcare utilization attributed to increased recognition, awareness, and reporting [9,10,11,12,13,14,15]. Publicly insured youth may have higher unmet needs and poorer outcomes after concussion compared to their privately insured counterparts [21] Concussionrelated visits for both publicly and privately insured youth increased in recent years due, in part, to concussion laws requiring youth to seek medical care for concussive injury in order to return to play [10, 15, 22]. Insured youth are more likely to use the ED as an initial point of entry for concussion treatment compared to privately insured youth, [23] while studies of privately insured youth show greater increases in primary care and specialty care [10, 24]
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