Predicting Low Resource Intensity Emergency Department Visits in Children

Samuels-Kalow, M.; Peltz, A.; Rodean, J.; Hall, M.; Alpern, E. R.; Aronson, P. L.; Berry, J. G.; Shaw, K. N.; Morse, R. B.; Freedman, S. B.; Cohen, E.; Simon, H. K.; Shah, S. S.; Katsogridakis, Y.; Neuman, M. I.

Acad Pediatr. 2018 Jan 15

Abstract

BACKGROUND AND OBJECTIVES: Interventions to reduce frequent emergency department (ED) use in children are often limited by the inability to predict future risk. We sought to develop a population-based model for predicting Medicaid-insured children at risk for high frequency of low-resource intensity (LRI) ED visits. METHODS: Retrospective cohort analysis of Medicaid-insured children (age 1-18 years) included in the MarketScan(R) Medicaid database with >/=1 ED visit(s) in 2013. LRI visits were defined as ED encounters with no laboratory testing, imaging, procedures or hospitalization; and high frequency as >/=3 LRI ED visits within 365-days of the initial encounter. A generalized linear regression model was derived and validated using a split-sample approach. Validity testing was conducted examining model performance using 3 alternative definitions of LRI. RESULTS: Among 743,016 children with >/=1 ED visit in 2013, 5% experienced high frequency LRI ED use, accounting for 21% of all LRI visits. History of prior LRI ED use [2 visits: aOR=3.5 (95% CI:3.3, 3.7), and >/=3 visits aOR=7.7 (95% CI:7.3, 8.1)] and presence of 3 or more chronic conditions [aOR=1.7 (95% CI:1.6, 1.8)] were strongly associated with future high frequency LRI ED use. A model incorporating patient characteristics and prior ED use predicted future high frequency LRI ED utilization with an area under the curve of 0.74. CONCLUSION: Demographic characteristics and patterns of prior ED use can predict future risk of high frequency LRI ED use in the following year. Interventions for reducing low-value ED use in these high-risk children should be considered.

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