Reliance on Acute Care Settings for Health Care Utilization: A Comparison of Adolescents With Younger Children.
Journal
Pediatric emergency care
ISSN: 1535-1815
Titre abrégé: Pediatr Emerg Care
Pays: United States
ID NLM: 8507560
Informations de publication
Date de publication:
01 Dec 2021
01 Dec 2021
Historique:
pubmed:
11
8
2020
medline:
18
12
2021
entrez:
11
8
2020
Statut:
ppublish
Résumé
Because a goal of the Affordable Care Act was to increase preventive care and reduce high-cost care, the objective of this study was to evaluate current health care use and reliance on acute care settings among Medicaid-enrolled children. This was a retrospective cohort study of the 2015 Truven Marketscan Medicaid claims database among children 0 to 21 years old with at least 11 months of continuous enrollment. We calculated adjusted probabilities of health care use (any health care use and ≥1 health maintenance visit) and high acute care reliance (ratio of emergency department or urgent care visits to all health care visits >0.33) by age and compared use between adolescents and younger children using multivariable logistic regression. Of the 5,182,540 Medicaid-enrolled children, 18.9% had no health care visits and 47.3% had 1 or more health maintenance visit in 2015. Both health care use and health maintenance visits decreased with increasing age (P < 0.001). Compared with younger children (0-10 years old), adolescents were more likely to have no interaction with the health care system [adjusted odds ratio (aOR), 2.20; 95% confidence interval (CI), 2.19-2.21] and less likely to have health maintenance visits (aOR, 0.40; 0.39-0.40). High acute care reliance was associated with increasing age, with adolescents having greater odds of high acute care reliance (aOR, 1.08; 1.08-1.09). Medicaid-enrolled adolescents have low rates of health care use and have high reliance on acute care settings. Further investigation into adolescent-specific barriers to health maintenance care and drivers for acute care is warranted.
Identifiants
pubmed: 32776762
pii: 00006565-202112000-00076
doi: 10.1097/PEC.0000000000001924
pmc: PMC7775320
mid: NIHMS1533380
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1128-e1132Subventions
Organisme : NICHD NIH HHS
ID : K23 HD070910
Pays : United States
Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Disclosure: The authors declare no conflict of interest.
Références
Park MJ, Scott JT, Adams SH, et al. Adolescent and young adult health in the United States in the past decade: little improvement and young adults remain worse off than adolescents. J Adolesc Health . 2014;55:3–16.
Nordin JD, Solberg LI, Parker ED. Adolescent primary care visit patterns. Ann Fam Med . 2010;8:511–516.
Ma J, Wang Y, Stafford RS. U.S. adolescents receive suboptimal preventive counseling during ambulatory care. J Adolesc Health . 2005;36:441.
Committee on Practice and Ambulatory Medicine; Bright Futures Periodicity Schedule Workgroup. 2017 recommendations for preventive pediatric health care. Pediatrics . 2017;139. pii: e20170254.
Booth ML, Bernard D, Quine S, et al. Access to health care among Australian adolescents young people's perspectives and their sociodemographic distribution. J Adolesc Health . 2004;34:97–103.
Elliott BA, Larson JT. Adolescents in mid-sized and rural communities: foregone care, perceived barriers, and risk factors. J Adolesc Health . 2004;35:303–309.
Wickman ME, Anderson NL, Greenberg CS. The adolescent perception of invincibility and its influence on teen acceptance of health promotion strategies. J Pediatr Nurs . 2008;23:460–468.
Ford CA, Millstein SG, Halpern-Felsher BL, et al. Influence of physician confidentiality assurances on adolescents' willingness to disclose information and seek future health care. A randomized controlled trial. JAMA . 1997;278:1029–1034.
Ziv A, Boulet JR, Slap GB. Emergency department utilization by adolescents in the United States. Pediatrics . 1998;101:987–994.
Dempsey AF, Freed GL. Health care utilization by adolescents on medicaid: implications for delivering vaccines. Pediatrics . 2010;125:43–49.
McCaig LF, Nawar EW. National Hospital Ambulatory Medical Care Survey: 2004 emergency department summary. Adv Data . 2006:1–29.
Klein JD, Wilson KM, McNulty M, et al. Access to medical care for adolescents: results from the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls. J Adolesc Health . 1999;25:120–130.
Wilson KM, Klein JD. Adolescents who use the emergency department as their usual source of care. Arch Pediatr Adolesc Med . 2000;154:361–365.
DeNavas-Walt CPB, Smith J. Income, poverty, and health insurance coverage in the United States: 2010 . Washington, DC: US Census Bureau; 2011.
Kroner EL, Hoffmann RG, Brousseau DC. Emergency department reliance: a discriminatory measure of frequent emergency department users. Pediatrics . 2010;125:133–138.
Adams SH, Park MJ, Twietmeyer L, et al. Association between adolescent preventive care and the role of the Affordable Care Act. JAMA Pediatr . 2018;172:43–48.
Schlichting LE, Rogers ML, Gjelsvik A, et al. Pediatric emergency department utilization and reliance by insurance coverage in the United States. Acad Emerg Med . 2017;24:1483–1490.
Samuels-Kalow M, Peltz A, Rodean J, et al. Predicting low-resource-intensity emergency department visits in children. Acad Pediatr . 2018;18:297–304.
Peltz A, Samuels-Kalow ME, Rodean J, et al. Characteristics of children enrolled in medicaid with high-frequency emergency department use. Pediatrics . 2017;140. pii: e20170962.
Berry JG, Rodean J, Hall M, et al. Impact of chronic conditions on emergency department visits of children using Medicaid. J Pediatr . 2017;182:267–274.
Neff JM, Sharp VL, Muldoon J, et al. Identifying and classifying children with chronic conditions using administrative data with the clinical risk group classification system. Ambul Pediatr . 2002;2:71–79.
Neff JM, Clifton H, Park KJ, et al. Identifying children with lifelong chronic conditions for care coordination by using hospital discharge data. Acad Pediatr . 2010;10:417–423.
O'Mahony L, O'Mahony DS, Simon TD, et al. Medical complexity and pediatric emergency department and inpatient utilization. Pediatrics . 2013;131:e559–e565.
National Committee for Quality Assurance NCfQ. NCQA Updates Quality Measures for HEDIS2017. Available at: http://www.ncqa.org/Portals/0/HEDISQM/HEDIS2017/HEDIS%202017%20Volume%202%20List%20of%20Measures.pdf?ver=2016-06-27-135433-350 . Published 2017.
Nikpay S, Freedman S, Levy H, et al. Effect of the Affordable Care Act Medicaid expansion on emergency department visits: evidence from state-level emergency department databases. Ann Emerg Med . 2017;70:215–225.e216.
Dresden SM, Powell ES, Kang R, et al. Increased emergency department use in Illinois after implementation of the Patient Protection and Affordable Care Act. Ann Emerg Med . 2017;69:172–180.
Pines JM, Zocchi M, Moghtaderi A, et al. Medicaid expansion in 2014 did not increase emergency department use but did change insurance payer mix. Health Aff (Millwood) . 2016;35:1480–1486.
Montalbano A, Rodean J, Canares T, et al. Urgent care utilization in the pediatric Medicaid population. J Pediatr . 2017;191:238–243.e231.
Wong CA, Bain A, Polsky D, et al. The use and out-of-pocket cost of urgent care clinics and retail-based clinics by adolescents and young adults compared with children. J Adolesc Health . 2017;60:107–112.
Klein JD, Slap GB, Elster AB, et al. Access to health care for adolescents. A position paper of the Society for Adolescent Medicine. J Adolesc Health . 1992;13:162–170.
Elster A, Jarosik J, VanGeest J, et al. Racial and ethnic disparities in health care for adolescents: a systematic review of the literature. Arch Pediatr Adolesc Med . 2003;157:867–874.
Glauser J. Rationing and the role of the emergency department as society's safety net. Acad Emerg Med . 2001;8:1101–1106.
Bohnert AS, Bonar EE, Cunningham R, et al. A pilot randomized clinical trial of an intervention to reduce overdose risk behaviors among emergency department patients at risk for prescription opioid overdose. Drug Alcohol Depend . 2016;163:40–47.
Cunningham RM, Chermack ST, Ehrlich PF, et al. Alcohol interventions among underage drinkers in the ED: a randomized controlled trial. Pediatrics . 2015;136:e783–e793.
Carter PM, Walton MA, Zimmerman MA, et al. Efficacy of a universal brief intervention for violence among urban emergency department youth. Acad Emerg Med . 2016;23:1061–1070.
Rhodes KV, Rodgers M, Sommers M, et al. Brief motivational intervention for intimate partner violence and heavy drinking in the emergency department: a randomized clinical trial. JAMA . 2015;314:466–477.
Ranney ML, Freeman JR, Connell G, et al. A depression prevention intervention for adolescents in the emergency department. J Adolesc Health . 2016;59:401–410.
Fein JA, Pailler ME, Barg FK, et al. Feasibility and effects of a Web-based adolescent psychiatric assessment administered by clinical staff in the pediatric emergency department. Arch Pediatr Adolesc Med . 2010;164:1112–1117.