Number Of Emergency Department Encounters Research Articles

Neighborhood Disadvantage and Healthcare Utilization in Pediatric Sickle Cell Patients

Background: Sickle cell disease (SCD) is a complex heritable blood disorder associated with higher acute healthcare utilization further complicated by psychosocial and socioeconomic factors. Other studies have indicated a relationship between neighborhood disadvantage and increased healthcare utilization. We hypothesize that those with greater neighborhood disadvantage will have greater acute healthcare utilization.
 Methods: Data was collected retrospectively from the electronic medical record between 9/30/2021 and 7/11/2023 for patients followed at Riley Hospital for Children’s Pediatric SCD Clinic who completed a psychosocial needs assessment (PAT). Number of emergency department (ED) visits, hospitalizations, and missed clinic visits were collected from the time the PAT was completed up to 1 year after (or the end of the data collection period). Data regarding area deprivation index (ADI) and childhood opportunity index (COI) were collected utilizing patient home address. Descriptive statistics were performed on all data above, as well as t-tests and chi square tests for univariate analyses.
 Results: 142 patients completed a PAT during the study period. 88% had a primary care provider documented, and 73% had public insurance. The median state and national ADI (6, 76.5) and COI (2, 2) demonstrated greater neighborhood disadvantage and less childhood opportunity. There was no statistically significant difference between ADI or COI and number of ED encounters or hospitalizations. However, patients who missed 1 or more SCD visits had a higher median state ADI than those who did not miss a visit (7.5 vs 5, p=0.002). Median state COI was also lower in this group than those who did not miss a visit (1 vs 2, p=0.001).
 Conclusion: Those with higher ADI and lower COI could benefit from more directed support to improve access to preventative care visits. Further analysis accounting for comorbidities (seizures, asthma, depression) could disambiguate a relationship between ADI or COI and acute care utilization.

Impact of Neighborhood Opportunity on Missed Clinic Visits and Acute Care Utilization in Individuals with Sickle Cell Disease

Background: Sickle cell disease (SCD) is a complex inherited blood disorder associated with high acute healthcare utilization, further complicated by psychosocial and socioeconomic factors. Social determinants of health (SDOH) have a known impact on healthcare access and health outcomes, particularly in minoritized communities. The Area Deprivation Index (ADI) is a composite measure of neighborhood socioeconomic disadvantage. The Childhood Opportunity Index (COI) is a validated approach for estimating multi-dimensional SDOH leading to inequitable distribution of opportunity across neighborhoods. Both have been associated with acute care utilization in pediatric populations other than SCD. We hypothesize that ADI and COI will be associated with acute care utilization and care access in SCD, as well. Methods: Data were collected retrospectively from the electronic medical record between September 2021 and July 2023 for patients followed at a Midwestern Pediatric SCD Clinic who completed a Psychosocial Assessment Tool (PAT) at an annual comprehensive visit. The PAT is a validated quantitative caregiver survey used to screen for psychosocial risk factors and resiliency, with subcategories such as social support, child problems, structure/resources, and family beliefs. Number of emergency department (ED) visits, hospitalizations, and missed clinic visits were collected from the time the PAT was completed up to 1 year after (or the end of the data collection period). The area deprivation index (ADI) and childhood opportunity index (COI) were determined utilizing census block data for the patient at the time the PAT was completed. Descriptive statistics were performed on all data above, as well as t-tests and chi square tests for univariate analyses. Results: One hundred seventy-four unique patients completed a PAT during the study period. The median age of the child with SCD was 11.5 years (range 4-22 years), with the majority having Hb SS disease (61%). Eighty-nine percent had a primary care provider documented and 75% had public insurance. The median state ADI (6) and COI (2) for the cohort demonstrated significant neighborhood disadvantage/SDOH for all patients (See Figure). Ninety-two unique patients had 239 ED encounters. Fifty-eight unique patients accounted for 149 hospitalizations. Forty-seven percent of those hospitalized had a PAT in the Targeted or Clinical range (i.e. increased psychosocial stressors) compared to 30% of those who had not been hospitalized ( p=0.04). There was no statistically significant difference between ADI or COI and number of ED encounters or hospitalizations. However, patients who missed 1 or more SCD visits (n=79) had a higher median state ADI than those who did not miss a visit (8 vs 6, p=0.009). Median state COI was also lower in this group than those who did not miss a visit (1 vs 2, p=0.008). Forty-eight percent of those who missed 1 or more SCD visit had a PAT in the Targeted or Clinical category versus 27% of those who did not miss any ( p=0.009). Conclusion: While those with significant SDOH and neighborhood disadvantage did not have higher rates of acute care utilization in this cohort, there was a significant contribution to missed preventative SCD care visits, further emphasizing the need for psychosocial support and resources as essential elements to SCD programs, as well as alternative forms of care delivery, such as telemedicine, to improve access to SCD specialists. Further studies are needed to understand the impact comprehensive resources such as these may have on care burden, as well as disease outcomes.

Emergency department visits and boarding for pediatric patients with suicidality before and during the COVID-19 pandemic.

To quantify the increase in pediatric patients presenting to the emergency department with suicidality before and during the COVID-19 pandemic, and the subsequent impact on emergency department length of stay and boarding. This retrospective cohort study from June 1, 2016, to October 31, 2022, identified patients ages 6 to 21 presenting to the emergency department at a pediatric academic medical center with suicidality using ICD-10 codes. Number of emergency department encounters for suicidality, demographic characteristics of patients with suicidality, and emergency department length of stay were compared before and during the COVID-19 pandemic. Unobserved components models were used to describe monthly counts of emergency department encounters for suicidality. There were 179,736 patient encounters to the emergency department during the study period, 6,215 (3.5%) for suicidality. There were, on average, more encounters for suicidality each month during the COVID-19 pandemic than before the COVID-19 pandemic. A time series unobserved components model demonstrated a temporary drop of 32.7 encounters for suicidality in April and May of 2020 (p<0.001), followed by a sustained increase of 31.2 encounters starting in July 2020 (p = 0.003). The average length of stay for patients that boarded in the emergency department with a diagnosis of suicidality was 37.4 hours longer during the COVID-19 pandemic compared to before the COVID-19 pandemic (p<0.001). The number of encounters for suicidality among pediatric patients and the emergency department length of stay for psychiatry boarders has increased during the COVID-19 pandemic. There is a need for acute care mental health services and solutions to emergency department capacity issues.

Association between continuity and access in primary care: a retrospective cohort study.

Continuity of care is a tenet of primary care. Our objective was to explore the relation between a change in access to a primary care physician and continuity of care. We conducted a retrospective cohort study among physicians in a primary care network in southwest Alberta who measured access consistently between 2009 and 2016. We used time to the third next available appointment as a measure of access to physicians. We calculated the provider and clinic continuity, discontinuity and emergency department use based on the physicians' own panels. Physicians who improved, worsened or maintained their level of access within a given year were assessed in multilevel models to determine the association with continuity of care at the physician and clinic levels and the emergency department. We analyzed data from 190 primary care physicians. Physicians with improved access increased provider continuity by 6.8% per year, reduced discontinuity by 2.1% per year, and decreased emergency department encounters by 78 visits per 1000 patients per year compared to physicians with stable access. Physicians with worsening access had a 6.2% decrease in provider continuity and an increased number of emergency department encounters (64 visits per 1000 panelled patients per year) compared to physicians with stable access. Changes in access to primary care can affect whether patients seek care from their own physician, from another clinic or at the emergency department. Improving access by reducing the delay in obtaining an appointment with one's primary care physician may be one mechanism to improve continuity of care.

Impact of a Rapid-Access Ambulatory Psychiatry Encounter on Subsequent Emergency Department Utilization.

The authors sought to determine whether providing a rapid-access ambulatory psychiatry encounter correlated with emergency department utilization during a 6-month follow-up period. Electronic medical records of patients who accessed ambulatory psychiatric care through an urgent care psychiatry clinic that offers treatment exclusively on a walk-in basis over a 1-year period (N = 157) were reviewed retrospectively to track emergency department encounters with and without a psychiatric chief complaint in the 6months before and after the initial psychiatry evaluation. Among patients who had not previously received ambulatory psychiatric care (N = 88), emergency department utilization decreased from 0.68 visits per patient to 0.36, and this difference was statistically significant (p = 0.0147). No statistically significant differences were found between the average number of emergency department encounters in the 6months before and after the rapid-access ambulatory psychiatry encounter, regardless of chief complaint, when all patients were included in the analysis. Providing a rapid-access ambulatory psychiatry encounter may reduce subsequent emergency department utilization among patients who have not previously received ambulatory psychiatric care.

Emergency Department Frequent Utilization for Non-Emergent Presentments: Results from a Regional Urban Trauma Center Study.

ObjectivesFirst, to test a model of the drivers of frequent emergency department utilization conceptualized as falling within predisposing, enabling, and need dimensions. Second, to extend the model to include social networks and service quality as predictors of frequent utilization. Third, to illustrate the variation in thresholds that define frequent utilization in terms of the number of emergency department encounters by the predictors within the model.Data SourcePrimary data collection over an eight week period within a level-1 trauma urban hospital’s emergency department.Study DesignRepresentative randomized sample of 1,443 adult patients triaged ESI levels 4–5. Physicians and research staff interviewed patients as they received services. Relationships with the outcome variable, utilization, were tested using logistic regression to establish odds-ratios.Principal Findings70.6 percent of patients have two or more, 48.3 percent have three or more, 25.3 percent have four or more, and 14.9 percent have five or more emergency department visits within 12 months. Factors associated with frequent utilization include gender, race, poor mental health, mental health drugs, prescription drug abuse, social networks, employment, perceptions of service quality, seriousness of condition, persistence of condition, and previous hospital admittance.ConclusionsInterventions targeting associated factors will change global emergency department encounters, although the mutability varies. Policy interventions to address predisposing factors such as substance abuse or access to mental health treatment as well as interventions that speak to enabling factors such as promoting the resiliency of social networks may result in decreased frequency of emergency department utilization.