Emergency Department Visits In Children Research Articles

Medical Costs of Respiratory Syncytial Virus–Associated Hospitalizations and Emergency Department Visits in Children Aged Younger Than 5 Years: Observational Findings from the New Vaccine Surveillance Network, 2016-2019

To assess medical costs of hospitalizations and emergency department (ED) care associated with respiratory syncytial virus (RSV) disease in children enrolled in the New Vaccine Surveillance Network. We used accounting and prospective surveillance data from 6 pediatric health systems to assess direct medical costs from laboratory-confirmed RSV-associated hospitalizations (n=2007) and ED visits (n=1267) from 2016 through 2019 among children aged <5years. We grouped costs into categories relevant to clinical care and administrative billing practices. We examined RSV-associated medical costs by care setting using descriptive and bivariate analyses. We assessed associations between known RSV risk factors and hospitalization costs and length of stay using χ2 tests of association. The median cost was $7100 (IQR $4006-$13 355) per hospitalized child and $503 (IQR $387-$930) per ED visit. Eighty percent (n=2628) of our final sample were children aged younger than 2years. Fewer weeks' gestational age was associated with greater median costs in hospitalized children (P<.001, ≥37weeks of gestational age: $6840 [$3905-$12 450]; 29-36weeks of gestational age: $7721 [$4362-$15 274]; <29 weeks of gestational age: $9131 [$4518-$19 924]). Infants born full term accounted for 70% of the total expenditures in our sample. Almost three quarters of the health care dollars spent originated in children younger than 12months of age, the primary age group targeted by recommended RSV prophylactics. Reducing the cost burden for RSV-associated medical care in young children will require prevention of RSV in all young children, not just high-risk infants. Newly available maternal vaccine and immunoprophylaxis products could substantially reduce RSV-associated medical costs.

Emergency Department Visits in Children Associated with Exposure to Ambient PM1 within Several Hours

Emerging evidence has integrated short-term exposure to PM1 with children's morbidity and mortality. Nevertheless, most available studies have been conducted on a daily scale, ignoring the exposure variations over the span of a day. The main intention of this study was to examine the association between pediatric emergency department visits (PEDVs) and intra-day exposures to PM1 and PM2.5. We also aimed to investigate whether a high PM1/PM2.5 ratio elevated the risk of PEDVs independent from PM2.5 exposure within several hours. We collected hourly data on aerial PM1 and PM2.5 concentrations, all-cause PEDVs, and meteorological factors from two megacities (i.e., Guangzhou and Shenzhen) in southern China during 2015-2016. Time-stratified case-crossover design and conditional logistic regression analysis were used to assess the associations of PEDVs with exposures to PM1 and PM2.5 at different lag hours. The contribution of PM1 to PM2.5-associated risk was quantified by introducing PM1/PM2.5 ratio as an additional exposure indicator in the analysis adjusting for PM2.5. Subgroup analyses were performed stratified by sex, age, and season. During this study period, 97,508 and 101,639 children were included from Guangzhou and Shenzhen, respectively. PM1 and PM2.5 exposures within several hours were both remarkably related to an increased risk of PEDVs. Risks for PEDVs increased by 3.9% (95% confidence interval [CI]: 2.7-5.0%) in Guangzhou and 3.2% (95% CI: 1.9-4.4%) in Shenzhen for each interquartile range (Guangzhou: 21.4 μg/m3, Shenzhen: 15.9 μg/m3) increase in PM1 at lag 0-3 h, respectively. A high PM1/PM2.5 ratio was substantially correlated with increased PEDVs, with an excess risk of 2.6% (95% CI: 1.2-4.0%) at lag 73-96 h in Guangzhou and 1.2% (95% CI: 0.4-2.0%) at lag 0-3 h in Shenzhen. Stratified analysis showed a clear seasonal pattern in PM-PEDVs relationships, with notably stronger risks in cold months (October to March of the following year) than in warm months (April to September). Exposures to ambient PM1 and PM2.5 within several hours were related to increased PEDVs. A high PM1/PM2.5 ratio may contribute an additional risk independent from the short-term impacts of PM2.5. These findings highlighted the significance of reducing PM1 in minimizing health risks due to PM2.5 exposure in children.

Poisoning-related emergency department visits in children with autism spectrum disorder

BackgroundAutism spectrum disorder (ASD) is a complex neurodevelopmental condition, and its prevalence has increased markedly in the past two decades. Research indicates that people with ASD are at increased risk for premature mortality from injuries. Often, children with ASD are prescribed multiple medications, increasing their risk for intentional and unintentional poisonings. We examined the epidemiologic patterns of emergency department (ED)-treated poisonings in children with ASD and the association of ED-treated poisonings with ASD according to common co-occurring conditions.MethodsWe analyzed data from the Nationwide Emergency Department Sample for 2016–2018 to estimate the frequencies of ED-treated poisonings among autistic children aged 1–20 years and adjusted odds ratios of ED-treated poisoning associated with ASD in the presence or absence of co-occurring attention-deficit hyperactivity disorder (ADHD) or intellectual disability (ID). The ICD-10-CM external cause-of-injury matrix was utilized to identify poisoning cases.ResultsDuring 2016–2018, there were an estimated 523,232 ED visits in children with ASD aged 1–20 years, including 12,152 (2.3%) visits for poisoning. Of ED-treated poisonings in children with ASD, 73.6% were related to pharmaceutical drugs, such as psychotropic medications and prescription opioids, 16.6% were intentional, 36.5% were unintentional, and 47.0% were undetermined. Among children with ASD, those aged 5–9 had the highest odds of poisoning-related ED visits compared to all other age-groups (adjusted OR = 3.41; 95% CI 3.15, 3.68). The odds of poisoning for children with ASD were 59.0% greater than for their peers (adjusted OR = 1.59; 95% CI 1.53, 1.66) and varied significantly with age and co-occurring ADHD or ID.ConclusionsChildren with ASD are at a significantly increased risk of poisoning, particularly among those aged 5–9 years. Co-occurring ADHD or ID with ASD further increases the risk of poisoning. Interventions to reduce poisoning in children with ASD should prioritize the safety of prescription medications.

Unintentional Acute Poisoning Related Emergency Department Visits in Children in a Single-Center: A Nine-Year Prospective Survey.

Pediatric morbidity due to unintentional poison exposure is a significant burden on public health. We prospectively characterize patterns of unintentional poison exposure in a single pediatric emergency department, using a detailed computerized questionnaire for all unintentional injuries admitted during 2009 to 2017. Out of 71,765 visits due to unintentional injuries, 252 children were admitted due to unintentional poison exposure. Most (198/252, 79%) were between 1 and 3 years of age. The majority of events (209/252, 82.9%) occurred at the patient's home and 81% (205/255) were classified as exploratory ingestion. In 41/252 (14%) cases, exposure to more than one substance was reported. Most events 231/293 (79%) involved medications and 21% were due to domestic products. Four medications account for 45% of the events (Paracetamol, Salbutamol, Antihypertensive, and Antidepressants). Opioids were responsible for only 1.7%. By, collaboration between government, public health, educational institutions and commercial companies, can the burden of pediatric unintentional poison exposure be reduced.

Partnering to Improve Pediatric Asthma Quality.

Partnering to Improve Pediatric Asthma Quality.

Child maltreatment and emergency department visits: a longitudinal birth cohort study from infancy to early adulthood

BackgroundChild maltreatment (CM) is a serious global public health issue, with documented impacts on health. ObjectiveTo examine the association between different levels of CM concern, and Emergency Department (ED) visits from infancy to early adulthood. Participants and settingIndividuals born in Adelaide, South Australia from January 1986 to June 2017 (N = 443,754). MethodsUsing linked administrative data, we examined frequency and adjusted rate ratios for all-cause and cause specific ED visits among individuals with varying levels of CM concern. ResultsCumulative mean ED visits to age 14.5 years were higher for individuals with any CM concern, ranging from 10.2 to 14.8, compared with 6.4 in persons with no recorded CM concern. Adjusted rate ratios for ED visits varied from 1.26 (95% CI: 1.23–1.30) to 1.54 (1.48–1.60) in children (birth to 12 years), 1.98 (CI: 1.92–2.04) to 4.34 (CI: 4.09–4.60) in adolescence and 2.22 (CI: 2.14–3.48) to 3.48 (3.27–3.72) in young adults, increasing with severity of maltreatment concerns. ED visits coded as self-harm or poisoning, injuries, substance use or mental illness were particularly high, with incidence rate ratios mostly 3 to 15 times for mental health/substance related visits and 1.5 to 3.2 for other accidents or injury for individuals with any CM concern versus none. ConclusionsThe high rate ratios for ED visits in children with CM concern, especially for self-harm, substance use and mental health during adolescence and adulthood highlights the enduring mental health needs of victims of child maltreatment, providing further impetus for prevention.

Abstract 9440: Incidence, Charge, and Outcomes of Emergency Department Visits for Children with Single Ventricle Congenital Heart Disease from 2006-2018

Introduction: Children with single ventricle (SV) congenital heart disease have high morbidity, mortality and resource utilization when admitted to the hospital but few data exist on emergency department (ED) visits. Understanding patterns in ED encounters among children with SV may target interventions to improve outcomes. We described a national sample of SV ED visits and evaluated patient characteristics, encounters, and trends in admissions, charge, and mortality. Methods: This retrospective cohort study evaluates ED encounter level data from the 2006-2018 Nationwide Emergency Department Sample. Patients &lt; 18y with SV were identified using ICD-9/10 codes. Results: From 2006-2018, 52,512 SV ED visits were identified. Most SV ED encounters were male (61%) and &lt; 4y (65%). Patients with &gt; 1 complex chronic condition (CCC) comprised nearly 1/3 encounters (32%). Half of encounters (49%) resulted in admission or transfer, and the median inflation-adjusted charge per ED encounter was $1,939 (IQR $1,098-3,217). Nearly 1 in 50 SV ED visits resulted in death, in the ED or during the associated admission. Independent predictors of admission included age &lt;1y [OR 2.60 (2.12, 3.19)], presenting to a metropolitan teaching hospital [OR 6.31 (4.53, 8.80)], presenting with HF [OR 7.70 (5.33, 11.12)], arrythmia [OR 2.81 (1.89, 4.18)], respiratory disease [OR 5.13 (4.13, 6.43)], or sepsis [OR 8.64 (4.09, 18.26)], and the presence of 1 [OR 2.15 (1.90, 2.42)] or &gt; 2 CCC’s [OR 6.89 (5.56, 8.53)]. Independent predictors of mortality included age &lt;1y [OR 8.55 (3.28, 22.32)], presenting with HF [OR 4.97 (2.99, 8.27)], and &gt; 2 CCC’s [OR 2.19 (1.43, 3.36)]. Annual SV visits increased from 3,082 to 5,483 ( p for trend=0.003) and the inflation-adjusted charge per ED encounter increased by 50%, from $1,760 to $2,612 ( p for trend=0.002). There was no identified change in mortality ( p for trend=0.08). Conclusions: Half of ED visits of children with SV result in admission/transfer and 2% result in death. While the incidence and charges of SV ED visits increased over the years studied, there was no identified change in mortality. The high admission/transfer rate for children with SV presenting to the ED reflect a high-risk population; further attention must be given to improving their outcomes.

Decreasing Emergency Department Visits for Children With Epilepsy.

Epilepsy and seizures represent a frequent cause of emergency department (ED) visits for patients. By implementing quality improvement (QI) methodology, we planned to decrease ED visits for children and adolescents with epilepsy. In 2016, a multidisciplinary team was created to implement QI methodology to address ED visits for patients with epilepsy. Based on previous successes, further ED visit reduction was deemed possible. Our aim statement was to decrease the number of ED visits, per 1000 established patients with epilepsy, from 13.03 to 11.6, by December 2019 and sustain for 1 year. We successfully decreased ED visits for seizure-related care in patients with epilepsy from 13.03% to 10.2% per 1,000 patients, which resulted in a centerline shift. Using QI methodology, we improved the outcome measure of decreasing ED visits for children with epilepsy. Implementations of these interventions can be considered at other institutions that may lead to similar results.

Disparities in Potentially Preventable Emergency Department Visits for Children with Asthma among Asian Americans, Pacific Islanders, and Whites in Hawai‘i

The cost burdens of potentially preventable emergency department visits for pediatric asthma were estimated for Asian Americans, Pacific Islanders, and Whites using Hawai‘i statewide 2015–2016 data. The cost burden of the 3234 preventable emergency department visits over the study period was over $1.9 million. Native Hawaiians had the largest proportion (36.5%) of all preventable emergency department visits and accounted for the highest costs for the two years at $709,698. After adjusting for other factors, costs for preventable pediatric-asthma-related emergency department visits differed significantly by age, insurance provider, and island of residency. Reducing potentially preventable emergency department visits would not only improve health disparities among Native Hawaiians compared to other racial or ethnic populations in Hawai‘i, but could also generate cost savings for public and private insurance payers.

Low-Resource Emergency Department Visits for Children With Complex Chronic Conditions.

Reducing emergency department (ED) use in children with complex chronic conditions (CCC) is a national health system priority. Emergency department visits with minimal clinical intervention may be the most avoidable. We assessed characteristics associated with experiencing such a low-resource ED visit among children with a CCC. A retrospective study of 271,806 ED visits between 2014 and 2017 among patients with a CCC in the Pediatric Health Information System database was performed. The main outcome was a low-resource ED visit, where no medications, laboratory, procedures, or diagnostic tests were administered and the patient was not admitted to the hospital. χ2 Tests and generalized linear models were used to assess bivariable and multivariable relationships of patients' demographic, clinical, and health service characteristics with the likelihood of a low- versus higher-resource ED visit. Sixteen percent (n = 44,111) of ED visits among children with CCCs were low-resource. In multivariable analysis, the highest odds of experiencing a low- versus higher-resource ED visit occurred in patients aged 0 year (vs 16+ years; odds ratio [OR], 3.9 [95% confidence interval {CI}, 3.7-4.1]), living <5 (vs 20+) miles from the ED (OR, 1.7 [95% CI, 1.7-1.8]), and who presented to the ED in the day and evening versus overnight (1.5 [95% CI, 1.4-1.5]). Infant age, living close to the ED, and day/evening-time visits were associated with the greatest likelihood of experiencing a low-resource ED visit in children with CCCs. Further investigation is needed to assess key drivers for ED use in these children and identify opportunities for diversion of ED care to outpatient and community settings.

Preventing Emergency Department Visits for Children With Medical Complexity Through Ambulatory Care: A Systematic Review.

Children with medical complexity (CMC) represent a growing population with high emergency department (ED) utilization. How to reduce preventable ED visits is poorly understood. We sought to determine what components of ambulatory care programs focused on CMC were most effective in preventing ED visits. PubMed Plus, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature databases through October 2019, and hand search of bibliographies. Two independent reviewers used a structured screening protocol to include English language articles summarizing studies that included CMC, emergency care, or ED utilization. Data on ED utilization were extracted. Sixteen included studies described outpatient interventions to prevent ED utilization. Of these, studies that included 24/7 access to knowledgeable providers for acute care needs by phone (telehealth) or expedited or next-day appointments were the most consistently successful in reducing ED visits. Risk of bias was mixed across studies. The evidence base is currently small and observational nature of interventions and their evaluations limit definitive, generalizable recommendations. Current research suggests that real-time access to knowledgeable providers and expedited appointments can prevent ED visits. Further study is needed to generalize these findings as well as investigate novel strategies such as telehealth to improve quality of care, decrease utilization, and provide cost-effective care for this vulnerable population.

Outcomes of Emergency Department Visits of Children After Kidney Transplantation

Outcomes of Emergency Department Visits of Children After Kidney Transplantation

Association of Protein and Endotoxin in Outdoor Air with Emergency Department Visits for Children and Adults with Asthma in Fukuoka, Japan.

We examined the association of biological components in airborne particles, i.e., proteins and endotoxins, in outdoor air with asthma exacerbation in the Fukuoka metropolitan area, Fukuoka, Japan. Data on emergency department (ED) visits for asthma in children (age, 0-14 years) and adults (age, 15-64 years) were collected at a medical center from December 2014 to November 2015. One hundred eighty-one children and 143 adults visited the ED for asthma, and the weekly number of ED visits in children increased in autumn, i.e., September (second week) to November (first week). Fine (aerodynamic diameter ≤2.5 µm) and coarse (≥2.5 µm) particles were collected for 3 or 4 weeks per month, and protein and endotoxin concentrations were analyzed. Protein was largely prevalent in fine particles (0.34-7.33 µg/m3), and concentrations were high in April, May, June, and October. In contrast, endotoxin was mainly included in coarse particles (0.0010-0.0246 EU/m3), and concentrations were high in September (third week), October (first, second, and fourth weeks), February (fourth week), and July (first week). The results of a Poisson regression analysis indicated that endotoxin (in fine and coarse particles alike) was a significant factor for ED visits related to asthma in children, even after adjusting for meteorological factors, i.e., temperature, relative humidity, and wind speed. However, there was no association between environmental factors and ED visits for asthma in adults. These results suggest that endotoxin in outdoor air is significantly associated with an increased risk of asthma exacerbation in children.

Nonresponse to Health-Related Social Needs Screening Questions.

Although clinical settings are increasingly screening for social determinants of health, essential questions about optimal screening remain. We aimed to assess primary care contexts of individuals choosing not to answer questions about health-related social needs and to compare screening question response with subsequent use of resource information. We compared caregiver responses to an electronic survey administered during a child's emergency department visit and through telephone follow-up 2 weeks later by responses to questions about health-related social needs (no social needs endorsed, ≥1 endorsed, none endorsed but ≥1 question not answered). Of 146 respondents, 42 (29%) endorsed ≥1 health-related social need. Additionally, 19 (13%) endorsed no social needs but did not answer ≥1 question. Compared with those denying all social needs and those endorsing ≥1 social need, respondents who did not answer social needs screening questions reported longer duration since their child's last primary care visit, lower perceptions of primary care, and less social support. For the 61 respondents participating in the 2-week follow-up survey, reported use of a community resource packet was 37% among those who had reported a social need, 26% among those who had denied all social needs, and 0% among those who had not answered ≥1 social needs questions. Clinicians and systems implementing screening for health-related social risks should plan for individuals who choose not to respond to specific items and may also wish to consider strategies that do not rely on screening and disclosure, particularly in communities known to have high prevalence of social needs.

Changes in Firearm and Medication Storage Practices in Homes of Youths at Risk for Suicide: Results of the SAFETY Study, a Clustered, Emergency Department–Based, Multisite, Stepped-Wedge Trial

We evaluate whether a counseling intervention implemented at the hospital level resulted in safer firearm and medication storage by caregivers of youths aged 10 to 17 years after their child's evaluation in the emergency department (ED) for a behavioral health concern. We used a stepped-wedge clustered design rolled out at 4 hospital sites to assess primary preregistered outcomes (self-reported storage changes caregivers made to household firearms and medications), assessed by survey 2 weeks after the ED visit. Three logistic models provided estimates of the intervention effect: an unadjusted model, a model with hospital-level fixed effects, and a model that further adjusts for time. Of the 575 caregiver participants, 208 were firearm owners (123 in usual care, 85 in the intervention). Baseline (pre-ED visit) characteristics did not differ between usual care and intervention phases. During the 2-year study period, twice as many caregivers whose child visited the ED after (compared with before) a hospital adopted the intervention improved firearm storage and 3 times as many improved medication storage (odds ratio [OR]=2.1 [95% confidence interval {CI} 1.0 to ∞] and OR=3.0 [95% CI 2.2 to ∞], respectively). After adjusting for time, the intervention effect for medications persisted (OR=2.0 [95% CI 1.0 to ∞]); the effect on firearms did not (OR=0.7 [95% CI 0.1 to ∞]). To our knowledge, this study is the first controlled trial to estimate the effectiveness of an intervention on firearm andmedication storage in homes of youths at elevated risk of suicide. We found evidence that caregivers' medication storageimproved after their child's ED visit, with evidence suggestive of improvement for firearm storage.

Variation in Hospitalization Rates Following Emergency Department Visits in Children with Medical Complexity

To evaluate factors associated with admission from emergency department (ED) encounters for children with medical complexity (CMC) and to quantify the hospital admission rate as well as variation in adjusted hospital admission rates across EDs. Retrospective study of 271 806 visits to 37 EDs in freestanding children's hospitals from January 1, 2014, to June 30, 2017, for patients of all ages with a complex chronic condition. Associations between patient demographic, clinical, and health services characteristics and the likelihood of hospital admission were identified using generalized linear models, which were then used to calculate adjusted hospital admission rates. Hospital admission occurred with 25.7% of ED visits. Characteristics with the greatest aOR of hospitalization were ≥3 compared with 0 prior hospitalizations in 365days (4.7; 95% CI, 4.5-4.9), ED arrival overnight compared with during workday 3.2 (95% CI, 3.1-3.3)], and ≥6 vs 0-1 chronic conditions (1.6; 95% CI, 1.5-1.6). Adjusted hospital admission rates varied significantly (P<.001) across EDs (21.1% [10th percentile]) and 30.0% [90th percentile]). Significant variation remained when excluding low-intensity ED visits, excluding hospitalizations requiring surgery and/or intensive care, or restricting the cohort to overnight ED arrival and to children with ≥3 prior hospitalizations. CMC are frequently admitted from the ED. Substantial variation in CMC hospital admission rates across EDs exists after case-mix adjustment.

Acceptance and Commitment Therapy for Parental Management of Childhood Asthma: An RCT.

Few trials have been conducted to address the psychological difficulties of parents in managing their child's asthma. Fostering parental psychological flexibility through Acceptance and Commitment Therapy (ACT) may help parents to accept these psychological difficulties and improve their management of childhood asthma. In this randomized controlled trial, a 4-session, group-based ACT plus asthma education (ACT group) was compared with an asthma education talk plus 3 telephone follow-ups (control group) to train parents of children diagnosed with asthma. The use of health care services due to asthma exacerbations in children and the psychological well-being of their parents were assessed before, immediately after, and at 6 months after the intervention. A total of 168 parents and their children aged 3 to 12 years with asthma were consecutively recruited in a public hospital in Hong Kong. When compared with the control group, children whose parents were in the ACT group made significantly fewer emergency department visits (adjusted 6-month incidence rate ratio = 0.20; confidence interval [CI] 0.08 to 0.53; P = .001) due to asthma exacerbations at 6 months postintervention. These parents also reported a decrease in psychological inflexibility (mean difference = -5.45; CI -7.71 to -3.30; P = .014), less anxiety (mean difference = -2.20; CI -3.66 to -0.73; P = .003), and stress (mean difference = -2.50; CI -4.54 to -0.47; P = .016). Integrating ACT into parental asthma education was effective at decreasing parental anxiety and stress and reducing the asthma-related emergency department visits of children at 6 months postintervention.

ASTHMA

Introduction: The prevalence of childhood asthma is increasing globally. Asthma is one of the main causes of hospitalization and frequent emergency department visits of children. The parents having awareness about asthma can comply with the treatment, avoidance from triggers and subsequently, they can control asthma symptoms in their children. Study Design: Cross- sectional analytical study. Setting: The Children’s Hospital and the Institute of Child Health, Lahore and Shaikh Zayed Hospital, Lahore in collaboration with University of Health Sciences Lahore. The Shaikh Zayed Hospital, Lahore is a tertiary care and an academic hospital as it is attached with Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College (Shaikh Zayed Hospital updates). The Children’s Hospital and Institute of Child Health, Lahore provides services of tertiary health care as well as allied facilities. Period: 12 months from 01-08-2013 to 01-07-2014. Methods: To assess the knowledge of parents of asthmatic children about the disease and to determine any association between asthma knowledge and the level of asthma control in their children. Subjects were parents with their asthmatic children ages between 4 to 12 years attending two exclusive pediatric hospitals at Lahore. A tool was constructed to assessparent’s knowledge about asthma, and a pre-validated asthma control tool was administered to determine asthma symptoms control in children. Data was represented in the form of figures, tables and chi square test was used to determine the association of knowledge about asthma,demographic information, and environmental information with different group of asthma control. Results: One hundred and ninety-six parents with their asthmatic children participated in this study. There was no association between asthma knowledge and the level of asthma control.There were 108 parents who had adequate knowledge about asthma, out of them only 45 (41.7%) children had asthma control. There were 88 parents who had inadequate knowledge about asthma. Out of them 36 (40.9%) children were with asthma control (p=.915). Conclusions:The findings of the study concluded that more than 50% (108/ 196) of the parents/ guardians have adequate knowledge about asthma and there was no association found between asthma knowledge and the level of asthma control. However, we need to empower Pakistani communityvia a national asthma awareness program, smoking cessation campaign and also empower the health care team with up-to-date knowledge about asthma management.

Health Care Utilization and Expenditures of Homeless Family Members Before and After Emergency Housing.

To describe longitudinal health service utilization and expenditures for homeless family members before and after entering an emergency shelter. We linked Massachusetts emergency housing assistance data with Medicaid claims between July 2008 and June 2015, constructing episodes of health care 12 months before and 12 months after families entered a shelter. We modeled emergency department visits, hospital admissions, and expenditures over the 24-month period separately for children and adults. Emergency department visits, hospital admissions, and expenditures rose steadily before shelter entry and declined gradually afterward, ending, in most cases, near the starting point. Infants, pregnant women, and individuals with depression, anxiety, or substance use disorder had significantly higher rates of all outcomes. Many children's emergency department visits were potentially preventable. Increased service utilization and expenditures begin months before families become homeless and are potentially preventable with early intervention. Infants are at greater risk. Public Health Implications. Early identification and intervention to prevent homeless episodes, focusing on family members with behavioral health disorders, who are pregnant, or who have young children, may save money and improve family health.

Predicting Low-Resource-Intensity Emergency Department Visits in Children

ObjectivesInterventions to reduce frequent emergency department (ED) use in children are often limited by the inability to predict future risk. We sought to develop a population-based model for predicting Medicaid-insured children at risk for high frequency (HF) of low-resource-intensity (LRI) ED visits. MethodsWe conducted a retrospective cohort analysis of Medicaid-insured children (aged 1–18 years) included in the MarketScan Medicaid database with ≥1 ED visit in 2013. LRI visits were defined as ED encounters with no laboratory testing, imaging, procedures, or hospitalization; and HF as ≥3 LRI ED visits within 365 days of the initial encounter. A generalized linear regression model was derived and validated using a split-sample approach. Validity testing was conducted examining model performance using 3 alternative definitions of LRI. ResultsAmong 743,016 children with ≥1 ED visit in 2013, 5% experienced high-frequency LRI ED use, accounting for 21% of all LRI visits. Prior LRI ED use (2 visits: adjusted odds ratio = 3.5; 95% confidence interval, 3.3, 3.7; and ≥3 visits: adjusted odds ratio = 7.7; 95% confidence interval, 7.3, 8.1) and presence of ≥3 chronic conditions (adjusted odds ratio = 1.7; 95% confidence interval, 1.6, 1.8) were strongly associated with future HF-LRI ED use. A model incorporating patient characteristics and prior ED use predicted future HF-LRI ED utilization with an area under the curve of 0.74. ConclusionsDemographic characteristics and patterns of prior ED use can predict future risk of HF-LRI ED use in the following year. Interventions for reducing low-value ED use in these high-risk children should be considered.