Trends in Emergency Department Use in the First Year of Life

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ESPR211
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Abstract: :

Background: Emergency department visits by young children have increased in the last decade. 

Objective: To examine trends and factors associated with Emergency Department (ED) use in the first year of life. 

Methods: We conducted a retrospective cohort study of infants born 10/1/2014-2/18/2019 receiving care at an urban academic pediatric practice and enrolled in a Medicaid Managed Care Organization (MCO) thourgh 11/3/2019. The MCO covers 40% of the patients in the practice. In addition to well child care, the practice offers same day acute care visits on weekdays. The data source was the MCO claims database. The primary outcome was ED use by 12 months of age; measures included number of ED visits, age at first ED visit, ED frequency of visits by infant age (in months), day of week and month of year, and correlation of number well visits with number of ED visits. Frequent ED use was defined as the 90th percentile for ED visits/child. In a multivariate regression, we controlled number of ED visits for sex, ethnicity, and well visits.   

Results: The study population included 1,472 infants: 69% African American, 24% Hispanic, 7% other; 50% females. By 12 months of age, infants made a median of zero ED visits, a mean of 0.48 (SD 0.99) and an interquartile mean of 0.5 ED visits. More than a third of the infants (n=580, 39.4%) made 1 or more ED visits: 14.5% made 1 visit, 10.6% made 2, 5.6% made 3 visits, 8.7% made 4 or more. The 90th percentile was at 3 ED visits. Most infants (54%) made their first ED visit by 4 months of age (Figure1).  However, the frequency of visits slightly increased throughout the first year of life. (Figure 2) ED visits were comparable across weekdays and weekend days. ED visits showed a seasonality effect, with higher number of visits in the winter months. We found a low but significant positive correlation between the number of well visits and the number of ED visits (Pearson R 0.27, CI 0.22 to 0.75, p<0.001). This significant association held in the multivariate regression, controlling for sex and ethnicity. 

Conclusions: Among infants receiving care in an academic pediatric practice and enrolled in a Medicaid Managed care plan, more than a third made an ED visit in their first year of life. ED use started very early in life, continued steadily through the first year of life, and showed a seasonality effect. The finding that infants with greater continuity of care were also more likely to make more ED visits merits further exploration.  

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Einstein Medical Center Philadelphia
Einstein Medical Center Philadelphia
Einstein Medical Center Philadelphia
Einstein Medical Center Philadelphia

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