Routine emergency department use for sick care by children in the United States.
ABSTRACT The use of the emergency departments as a regular source of sick care has been increasing, despite the fact that it is costly and is often an inappropriate source of care. This study examines factors associated with routine use of emergency departments by using a national sample of US children.
Data from the 1988 National Health Interview Survey on Child Health, a nationally representative sample of 17710 children younger than 18 years, was linked to country-level health resource data from the Area Resource File. Bivariate and multivariate analyses were used to assess the association between children's use of emergency departments as their usual sources of sick care and predisposing need and enabling characteristics of the families, as well as availability of health resources in their communities.
In 1988 3.4% or approximately 2 million US children younger than 18 years were reported to use emergency departments as their usual sources of sick care. Significant demographic risk factors for reporting an emergency department as a usual source of sick care included black versus white race (odds ratio [OR], 2.08), single-parent versus two-parent families (OR, 1.53), mothers with less than a high school education versus those with high school or more (OR, 1.76), poor versus nonpoor families (OR, 1.76), and living in an urban versus suburban setting (OR, 1.38). Specific indicators of need, such as recurrent health conditions (asthma, tonsillitis, headaches, and febrile seizures), were not associated with routine use of emergency departments for sick care. Furthermore, health insurance status and specifically Medicaid coverage had no association with use of the emergency department as a usual source of sick care. Compared with children who receive well child care in private physicians' offices or health maintenance organizations, children whose sources of well child care were neighborhood health centers were more likely to report emergency departments for sick care (OR, 2.01). Children residing in counties where the supply of primary care physicians was in the top quintile had half the odds (OR, 0.50) of reporting emergency departments as usual sources of sick care.
Reliance on hospital emergency departments for routine sick care is strongly associated with demographic and social characteristics of the child and family, the type and source of available well child care, and the supply of primary care physicians. Because health insurance status was not a significant predictor of use, public policies aimed at reducing the use of emergency departments by children will need to address other factors. These include the organizational characteristics and responsiveness of the health care system and the motivation of families for routine use of hospital emergency departments.
Article: Prior treatment of fracture patients in a tertiary pediatric emergency department: informal referrals from other emergency departments.[show abstract] [hide abstract]
ABSTRACT: The purposes of this study were to determine the following: (1) the percentage of fracture patients at a tertiary pediatric emergency department (ED) who previously sought treatment for the injury elsewhere and (2) how often such patients were sent from another ED. A prospective survey was conducted in the ED of a tertiary pediatric medical center in a large metropolitan area. Patients who presented with suspected extremity fractures and previously sought treatment elsewhere were asked where they had sought treatment and whether staff at another ED had told them to come to the tertiary ED. Demographic, clinical, insurance, and transfer information were also collected. Ninety-two patients who had sought previous care for the injury elsewhere participated in the survey, with 82 (89%) ultimately being diagnosed with fractures. This represents 33% (82/246) of the patients with extremity fractures treated by the participating ED physicians during the study. Seventy-nine percent (73/92) of the subjects had previously sought treatment at another ED. For those who did not also visit a regular physician, 69% (37/54) were told to come to the tertiary ED by staff at the initial ED. No differences were observed based on race or insurance status because the study subjects were predominantly minority (91%, including 80% Hispanic) and lacking private insurance (84%). Seeking follow-up care in a tertiary ED, often on the advice of staff from another ED, is a common practice for this largely minority and poorly insured population. Because patients did not present to our ED until an average of 3 days after injury and many had been discharged to a primary care physician, it is likely that many of the patients did not require emergency care. This practice inefficiently uses limited emergency care resources. Level II prospective survey.Journal of pediatric orthopedics 04/2009; 29(2):137-41. · 1.23 Impact Factor
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ABSTRACT: To examine determinants of quality of care provided by pediatric emergency departments (PEDs) in tertiary European centers. Analysis of questionnaires was sent to directors of PEDs. Questionnaires were sent through the pediatric research group of the European Society for Emergency Medicine. Three major descriptive categories were included in a 28-point questionnaire: institution's pediatric inpatient capabilities, scope of services, and medical staff education and structure. Sixty-five questionnaires were completed in full. Fifty-three tertiary medical centers from 14 countries were included in the study. In 86.8% of these institutions, the PED is separated from the adult emergency department; 91% have a pediatric intensive care unit, and 72% have an in-patient pediatric trauma service. Eighty-eight percent of the PEDs have incorporated triage protocols. Social service was not available in 17% of the departments. Sedation for painful procedures is provided by the staff in 77% of the PEDs. Only 24% of the PED medical directors have been formally trained in pediatric emergency medicine. In 17% of the departments, there is a 24-hour 7-day residents' coverage with no attending pediatrician or pediatric emergency medicine-trained physician. According to this pilot study, the basic services provided by tertiary PEDs in Europe appear to be appropriate. Physicians training level and staffing may not be adequate to achieve optimal patient outcome.Pediatric emergency care 07/2008; 24(6):359-63. · 0.92 Impact Factor
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ABSTRACT: This study sought to examine the shape and magnitude of family income gradients in US children's health, access to care, and use of services. We analyzed cross-sectional data from the 2003 National Survey of Children's Health, a telephone survey of 102,353 parents of children aged 0-17 years. Associations between family income [Below 100% Federal Poverty Level (FPL), 100-199% FPL, 200-299% FPL, 300-399% FPL, 400% FPL or Greater] and a set of 32 health and health care indicators were examined using linear polynomial testing and multivariate logistic regression. The percentage of children in better health increased with family income for 15 health outcomes. In multivariate logistic regression models that controlled for health insurance coverage and socio-demographic confounders, odds ratios >2 comparing the lowest to the highest income groups were noted for health conditions across both physical and developmental domains (diabetes, headaches, ear infections, learning disabilities, behavior/conduct problems, speech problems). Parent-reported global child health status, activity limitation, and oral health status showed steeper gradients than specific chronic and acute conditions. Ten measures of health care access and utilization were associated with family income in multivariate logistic regression models. Income gradients are pervasive across many health indicators at an early age. Social and health policy interventions are needed to address the multitude of factors that can affect children's health and initiate disparities in development.Maternal and Child Health Journal 06/2009; 14(3):332-42. · 2.24 Impact Factor