Characteristics of low-severity emergency department use among CHIP enrollees

Justin Blackburn, David J. Becker, Bisakha Sen, Michael A. Morrisey, Cathy Caldwell, Nir Menachemi

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objectives: To describe patient characteristics among those utilizing the emergency department (ED) for low-severity conditions (ie, conditions potentially treatable or manageable in a primary care setting). Study Design: A pooled cross-sectional study of administrative claims for ED visits among enrollees in Alabama's Children's Health Insurance Program (CHIP), ALL Kids, from January 1, 1999, through December 31, 2010. Methods: Severity of visit was categorized based on primary diagnosis code using an established claims-based algorithm. Logistic regression was used to identify patient characteristics that predicted low-severity ED visits relative to high-severity visits. Results: Of a total of 141,709 qualifying ED visits, 97,961 (69%) were classified as low severity, 33,941 (24%) as intermediate severity, and 9807 (7%) as high severity. Based on absolute risk differences, we found that among children utilizing the ED, low-severity visits were more likely than high-severity visits among children who were noncompliant with recommended well-child care (1.2 percentage points, 95% confidence interval [CI], 0.4-1.9); children who were nonurban residents (urban vs isolated: 1.6 percentage points, 95% CI, 1.0-2.2; urban vs small rural: 1.1 percentage points, 95% CI, 0.5-1.7); children without chronic disease (10.3 percentage points, 95% CI, 9.9-10.7) and children whose ED visits were on Sunday versus weekdays (0.9 percentage point, 95% CI, 0.6-1.3), and on Saturday versus weekdays (1.2 percentage points; 95% CI, 0.8-1.6). Conclusions: Our results suggest that improving access to primary care on weekends and in rural areas are potential ways to improve the efficient use of ED services.

Original languageEnglish (US)
JournalAmerican Journal of Managed Care
Volume19
Issue number12
StatePublished - Dec 1 2013
Externally publishedYes

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Hospital Emergency Service
Confidence Intervals
Primary Health Care
Child Care
Children's Health Insurance Program
Chronic Disease
Cross-Sectional Studies
Logistic Models

ASJC Scopus subject areas

  • Health Policy
  • Medicine(all)

Cite this

Characteristics of low-severity emergency department use among CHIP enrollees. / Blackburn, Justin; Becker, David J.; Sen, Bisakha; Morrisey, Michael A.; Caldwell, Cathy; Menachemi, Nir.

In: American Journal of Managed Care, Vol. 19, No. 12, 01.12.2013.

Research output: Contribution to journalArticle

Blackburn, Justin ; Becker, David J. ; Sen, Bisakha ; Morrisey, Michael A. ; Caldwell, Cathy ; Menachemi, Nir. / Characteristics of low-severity emergency department use among CHIP enrollees. In: American Journal of Managed Care. 2013 ; Vol. 19, No. 12.
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abstract = "Objectives: To describe patient characteristics among those utilizing the emergency department (ED) for low-severity conditions (ie, conditions potentially treatable or manageable in a primary care setting). Study Design: A pooled cross-sectional study of administrative claims for ED visits among enrollees in Alabama's Children's Health Insurance Program (CHIP), ALL Kids, from January 1, 1999, through December 31, 2010. Methods: Severity of visit was categorized based on primary diagnosis code using an established claims-based algorithm. Logistic regression was used to identify patient characteristics that predicted low-severity ED visits relative to high-severity visits. Results: Of a total of 141,709 qualifying ED visits, 97,961 (69{\%}) were classified as low severity, 33,941 (24{\%}) as intermediate severity, and 9807 (7{\%}) as high severity. Based on absolute risk differences, we found that among children utilizing the ED, low-severity visits were more likely than high-severity visits among children who were noncompliant with recommended well-child care (1.2 percentage points, 95{\%} confidence interval [CI], 0.4-1.9); children who were nonurban residents (urban vs isolated: 1.6 percentage points, 95{\%} CI, 1.0-2.2; urban vs small rural: 1.1 percentage points, 95{\%} CI, 0.5-1.7); children without chronic disease (10.3 percentage points, 95{\%} CI, 9.9-10.7) and children whose ED visits were on Sunday versus weekdays (0.9 percentage point, 95{\%} CI, 0.6-1.3), and on Saturday versus weekdays (1.2 percentage points; 95{\%} CI, 0.8-1.6). Conclusions: Our results suggest that improving access to primary care on weekends and in rural areas are potential ways to improve the efficient use of ED services.",
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