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Giannouchos TV, Ukert B, Pirrallo RG, Smith J, Kum HC, Wright B, Dietrich A. Determinants of Persistent, Multi-Year, Frequent Emergency Department Use Among Children and Young Adults in Three US States. Acad Pediatr 2024; 24:442-450. [PMID: 37673206 DOI: 10.1016/j.acap.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 07/11/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE This study examines the factors associated with persistent, multi-year, and frequent emergency department (ED) use among children and young adults. METHODS We conducted a retrospective secondary analysis using the 2012-2017 Healthcare Cost and Utilization Project State Emergency Department Databases for children and young adults aged 0-19 who visited any ED in Florida, Massachusetts, and New York. We estimated the association between persistent frequent ED use and individuals' characteristics using multivariable logistic regression models. RESULTS Among 1.3 million patients with 1.8 million ED visits in 2012, 2.9% (37,558) exhibited frequent ED use (≥4 visits in 2012) and accounted for 10.2% (181,138) of all ED visits. Longitudinal follow-up of frequent ED users indicated that 15.4% (5770) remained frequent users periodically over the next 1 or 2 years, while 2.2% (831) exhibited persistent frequent use over the next 3-5 years. Over the 6-year study period, persistent frequent users had 31,551 ED visits at an average of 38.0 (standard deviation = 16.2) visits. Persistent frequent ED use was associated with higher intensity of ED use in 2012, public health insurance coverage, inconsistent health insurance coverage over time, residence in non-metropolitan and lower-income areas, multimorbidity, and more ED visits for less medically urgent conditions. CONCLUSIONS Clinicians and policymakers should consider the diverse characteristics and needs of pediatric persistent frequent ED users compared to broader definitions of frequent users when designing and implementing interventions to improve health outcomes and contain ED visit costs.
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Affiliation(s)
- Theodoros V Giannouchos
- Department of Health Policy & Organization (TV Giannouchos), School of Public Health, The University of Alabama at Birmingham, Birmingham, Ala.
| | - Benjamin Ukert
- Department of Health Policy and Management (B Ukert, H-C Kum), School of Public Health, Texas A and M University, College Station, Tex
| | - Ronald G Pirrallo
- University of South Carolina School of Medicine (RG Pirrallo, J Smith, and A Dietrich), Greenville, SC; Department of Emergency Medicine (RG Pirrallo, J Smith, and A Dietrich), Prisma Health, Greenville, SC
| | - Jeremiah Smith
- University of South Carolina School of Medicine (RG Pirrallo, J Smith, and A Dietrich), Greenville, SC; Department of Emergency Medicine (RG Pirrallo, J Smith, and A Dietrich), Prisma Health, Greenville, SC
| | - Hye-Chung Kum
- Department of Health Policy and Management (B Ukert, H-C Kum), School of Public Health, Texas A and M University, College Station, Tex
| | - Brad Wright
- Department of Health Services Policy and Management (B Wright), Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Ann Dietrich
- University of South Carolina School of Medicine (RG Pirrallo, J Smith, and A Dietrich), Greenville, SC; Department of Emergency Medicine (RG Pirrallo, J Smith, and A Dietrich), Prisma Health, Greenville, SC
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Diaz J, Taboada I, Abreu A, Vargas L, Polanco Y, Zorrilla A, Beatty N. Evaluating Rural Health Disparities in Colombia: Identifying Barriers and Strategies to Advancing Refugee Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6948. [PMID: 37887686 PMCID: PMC10606581 DOI: 10.3390/ijerph20206948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
Health disparities within rural communities, notably those affecting migrant and refugee populations, are well-documented. Refugees often grapple with high disease burdens and mortality rates due to limited access to primary healthcare and their vulnerable socio-economic and political situations. This issue is particularly acute in the rural areas around Medellin, Colombia, where the refugee influx exacerbates the existing public health challenges. Studies highlight a substantial gap between community needs and public health policies, resulting in inadequate healthcare access. Our study, utilizing the Delphi technique, aimed to identify common barriers and strategies to enhance rural healthcare for refugees. Through consensus-building with community leaders, we identified six primary barriers to healthcare access and five barriers to healthcare quality. Community leaders endorsed five strategies to address the access barriers and eight strategies to improve healthcare quality. This research provides valuable insights for optimizing resource allocation and designing effective support programs for these vulnerable populations.
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Affiliation(s)
- John Diaz
- Gulf Coast Research and Education Center, University of Florida, Plant City, FL 33563, USA
| | - Isabel Taboada
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (I.T.); (A.A.); (L.V.); (A.Z.); (N.B.)
| | - Adriana Abreu
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (I.T.); (A.A.); (L.V.); (A.Z.); (N.B.)
| | - Lara Vargas
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (I.T.); (A.A.); (L.V.); (A.Z.); (N.B.)
| | - Ysabel Polanco
- Faculty of Medicine, University of Antioquia, Medellin 050010, Antioquia, Colombia;
| | - Alex Zorrilla
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (I.T.); (A.A.); (L.V.); (A.Z.); (N.B.)
| | - Norman Beatty
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (I.T.); (A.A.); (L.V.); (A.Z.); (N.B.)
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA
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Pogge G, Fedele DA, Waters EA, Maki J, Hunleth JM, Prabhakaran S, Bowen DJ, Shepperd JA. Exploring Caregiver Interest in and Preferences for Interventions for Children With Risk of Asthma Exacerbation: Web-Based Survey. JMIR Form Res 2023; 7:e46341. [PMID: 37531188 PMCID: PMC10433025 DOI: 10.2196/46341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Maintaining control of asthma symptoms is the cornerstone of asthma treatment guidelines in the United States. However, suboptimal asthma control and asthma exacerbations among young people are common and are associated with many negative outcomes. Interventions to improve asthma control are needed. For such interventions to be successful, it is necessary to understand the types of interventions that are appealing to caregivers of children with different levels of risk of exacerbation. OBJECTIVE This study aimed to evaluate whether caregivers of children with high (vs low) risk of asthma exacerbation show different levels of interest in and preferences for potential intervention programs and delivery methods. METHODS We contracted with Ipsos to administer a web-based survey to caregivers of children with asthma who were residing in the United States. Caregivers (N=394) reported their interest (1=not at all; 3=a lot) in 9 possible intervention programs and 8 possible intervention delivery methods. Caregivers also indicated their preferences by selecting the 3 intervention programs and 3 delivery methods that "most" interested them. Finally, caregivers completed 2 open-ended questions asking what other resources might be useful for managing their children's asthma. We classified children as having a high risk of exacerbation if they had an exacerbation in the past 3 months (n=116) and a low risk of exacerbation if otherwise (n=278). RESULTS Caregivers reported higher levels of interest in all intervention programs and delivery methods if they cared for a child with a high risk rather than a low risk of exacerbation. However, regardless of the child's risk status, caregivers expressed the highest levels of interest in programs to increase their child's self-management skills, to help pay for asthma care, and to work with the school to manage asthma. Caregivers expressed the highest levels of interest in delivery methods that maintained personal control over accessing information (websites, videos, printed materials, and smartphone apps). Caregivers' preferences were consistent with their interests; programs and delivery methods that were rated as high in interest were also selected as one of the 3 that "most" interested them. Although most caregivers did not provide additional suggestions for the open-ended questions, a few caregivers suggested intervention programs and delivery methods that we had not included (eg, education about avoiding triggers and medication reminders). CONCLUSIONS Similar interests and preferences among caregivers of children with high and low risk of exacerbation suggest a broad need for support in managing childhood asthma. Providers could help caregivers by directing them toward resources that make asthma care more affordable and by helping their children with asthma self-management. Interventions that accommodate caregivers' concerns about having personal control over access to asthma information are likely to be more successful than interventions that do not.
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Affiliation(s)
- Gabrielle Pogge
- Department of Psychology, University of Florida, Gainesville, FL, United States
| | - David A Fedele
- Department of Psychology, University of Florida, Gainesville, FL, United States
| | - Erika A Waters
- Division of Public Health Sciences, Washington University in St Louis, St Louis, MO, United States
| | - Julia Maki
- Division of Public Health Sciences, Washington University in St Louis, St Louis, MO, United States
| | - Jean M Hunleth
- Division of Public Health Sciences, Washington University in St Louis, St Louis, MO, United States
| | | | - Deborah J Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle, WA, United States
| | - James A Shepperd
- Department of Psychology, University of Florida, Gainesville, FL, United States
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Postdischarge Racial and Ethnic Disparities in Pediatric Appendicitis: A Mediation Analysis. J Surg Res 2023; 282:174-182. [PMID: 36308900 DOI: 10.1016/j.jss.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/11/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Significant racial and ethnic disparities exist for children presenting with acute appendicitis; however, it is unknown if disparities persist after initial management and hospital discharge. MATERIALS AND METHODS We performed a retrospective cohort study of children (aged < 18 y) who underwent treatment for acute appendicitis in 47 U.S. Children's Hospitals between 2017 and 2019. Primary outcomes were 30-d emergency department (ED) visits and 30-d inpatient readmission. Hierarchical multivariable logistic regression models were developed to determine the association of race and ethnicity on the primary outcomes. Inverse odds-weighted mediation analyses were used to estimate the degree to which complicated disease, insurance status, urbanicity, and residential socioeconomic status- mediated disparate outcomes. RESULTS A total of 67,303 patients were included. Compared with Non-Hispanic White children, Non-Hispanic Black (NHB) (odds ratio [OR] 1.40, 95% confidence interval [CI] 1.23-1.59) and Hispanic/Latinx (HL) children (OR 1.55, 95% CI 1.44-1.67) had higher odds of ED visits. Only NHB children had higher odds of readmission (OR 1.43, 95% CI 1.30-1.57). On a multivariable analysis, NHB (adjusted OR 1.19, 95% CI 1.04-1.36) and HL (adjusted OR 1.19, 95% CI 1.09-1.31) children had higher odds of ED visits. Insurance, disease severity, socioeconomic status, and urbanicity mediated 61.6% (95% CI 29.7-100%) and 66.3% (95% CI 46.9-89.3%) of disparities for NHB and HL children, respectively. CONCLUSIONS Children of racial and ethnic minorities are more likely to visit the ED after treatment for acute appendicitis, but HL patients did not have a corresponding increase in readmission. These differences were mediated mainly by insurance status and urban residence. A lack of appropriate postdischarge education and follow-up may drive disparities in healthcare utilization after pediatric appendicitis.
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Puvvula J, Poole JA, Gwon Y, Rogan EG, Bell JE. Role of social determinants of health in differential respiratory exposure and health outcomes among children. BMC Public Health 2023; 23:119. [PMID: 36650500 PMCID: PMC9847182 DOI: 10.1186/s12889-022-14964-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Attributes defining the Social Determinants of Health (SDoH) are associated with disproportionate exposures to environmental hazards and differential health outcomes among communities. The dynamics between SDoH, disproportionate environmental exposures, and differential health outcomes are often specific to micro-geographic areas. METHODS This study focused on children less than 20 years of age who lived in Douglas County, Nebraska, during 2016-2019. To assess the role of SDoH in differential exposures, we evaluated the association between SDoH metrics and criteria pollutant concentrations and the association between SDoH and pediatric asthma exacerbations to quantify the role of SDoH in differential pediatric asthma outcomes. The Bayesian Poisson regression model with spatial random effects was used to evaluate associations. RESULTS We identified significant positive associations between the annual mean concentration of criteria pollutants (carbon monoxide, particulate matter2.5, nitrogen dioxide, sulfur dioxide) with race (Non-Hispanic Black and Hispanic/Latino), financial stability, and literacy. Additionally, there were significant positive associations between higher rates of pediatric asthma emergency department visits and neighborhoods with more Non-Hispanic Black children, children without health insurance coverage, and households without access to a vehicle. CONCLUSIONS Non-Hispanic Black and Hispanic/Latino children living in Douglas County, NE experience disproportionately higher exposure to criteria pollutant concentrations. Additionally, higher rates of asthma exacerbations among Non-Hispanic Black children could be due to reduced access to respiratory care that is potentially the result of financial instability and vehicle access. These results could inform city planners and health care providers to mitigate respiratory risks among these higher at-risk populations.
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Affiliation(s)
- Jagadeesh Puvvula
- Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Jill A. Poole
- grid.266813.80000 0001 0666 4105Division of Allergy and Immunology, Department of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Yeongjin Gwon
- grid.266813.80000 0001 0666 4105Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Eleanor G. Rogan
- grid.266813.80000 0001 0666 4105Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Jesse E. Bell
- grid.266813.80000 0001 0666 4105Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE USA ,grid.24434.350000 0004 1937 0060School of Natural Resources, University of Nebraska-Lincoln, Lincoln, NE USA ,grid.24434.350000 0004 1937 0060Daugherty Water for Food Global Institute, University of Nebraska, Lincoln, NE USA
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Bullock GS, Mobley JF, Brooks JM, Rauh MJ, Gil Gilliland R, Kissenberth MJ, Shanley E. Uses of Health Care System Medical Care Services by Athletes After Injury at the High School Level. THE JOURNAL OF SCHOOL HEALTH 2023; 93:5-13. [PMID: 36263850 PMCID: PMC10091823 DOI: 10.1111/josh.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/03/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Health care utilization can vary by age group, geographic location, and socioeconomic status (SES). A paucity of information exists regarding the availability and utilization of medical care by injured scholastic athletes. The purpose of this study was to describe and compare injuries and health care service utilization by school SES over an academic year. METHODS Injury and health care service data was collected from 1 large school district. Percentage of free and reduced lunch (FRPL) for each school was calculated to stratify schools into high (<50% FRPL) and low (≥50.1% FRPL) SES groups. Incidence proportion and relative risk (RR) with 95% confidence intervals (95% CI) were calculated. RESULTS About 1756 injuries were reported among over 7000 participating athletes from 14 high schools. Similar injury incidence proportions were reported between high and low SES schools (RR = 1.10 [1.00-1.20]). Athletes from low SES schools were twice (RR = 2.01 [1.21-3.35]) and over three (RR = 3.42 [1.84-6.55]) times more likely to receive emergency and physical therapy care. SES was not associated with the use of physician, imaging, or surgery services. IMPLICATIONS FOR SCHOOL HEALTH, POLICY, AND EQUITY School medical providers and administrators should have ready and provide a list of trusted outside primary care and specialty providers that have experience in sports medicine. They should also enquire and follow up on which outside provider the high school athlete will seek care when referring out to outside providers. CONCLUSIONS Injury incidence was similar between high and low SES schools. However, athletes from low SES high schools were over 2-fold more likely to use emergency department services. Understanding factors influencing health care services choice and usage by student athletes from different socioeconomic backgrounds may assist sport medicine clinicians in identifying barriers and potential solutions in improving time to health restoration, athlete outcomes, and health care monetary burden.
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Affiliation(s)
- Garrett S. Bullock
- Department of Orthopaedic Surgery & Rehabilitation, Wake Forest School of Medicine, Winston‐Salem, NC; Centre for Sport, Exercise and Osteoarthritis Research Versus ArthritisUniversity of OxfordOxfordUK
| | - John F. Mobley
- University of South Carolina School of MedicineColumbiaSC
| | - John M. Brooks
- South Carolina Center for Effectiveness Research in OrthopaedicsUniversity of South CarolinaColumbiaSC
| | - Mitchel J. Rauh
- College of Health and Human ServicesSand Diego State UniversitySan DiegoCA
| | | | | | - Ellen Shanley
- University of South Carolina Center for Rehabilitation and Reconstruction Sciences, Greenville, SC; ATI Physical TherapyGreenvilleSC
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Mörelius E, Munns A, Smith S, Nelson HJ, McKenzie A, Ferullo J, Gill FJ. Pediatric and child health nursing: A three-phase research priority setting study in Western Australia. J Pediatr Nurs 2022; 63:39-45. [PMID: 34973465 DOI: 10.1016/j.pedn.2021.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/22/2021] [Accepted: 12/16/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE Priority settings are important to plan and direct future research. The aim of this study was to identify the top ten pediatric and child health nursing research priorities from the perspectives of consumers, community, and healthcare professionals in Western Australia. DESIGN AND METHODS This study used an adapted James Lind Alliance Priority Setting Partnership design with three phases. 1) A planning workshop to inform a survey. 2) A survey using five open-ended-questions distributed between October 2020 and January 2021 through social media and healthcare professionals' emails. Responders' statements were analyzed with content analysis. 3) A consensus workshop to finalize and rank the themes. RESULTS The planning workshop participants (n = 25) identified gaps such as community child healthcare and confirmed lack of consumer engagement in previous studies. The survey responses (n = 232) generated 911 statements analyzed into 19 themes. The consensus workshop participants (n = 19) merged and added themes, resulting in 16 final themes. The top three ranked themes were: 'access to service', 'mental health and psychological wellbeing', and 'communication'. CONCLUSIONS The research themes are necessarily broad to capture the wide range of issues raised, reflecting the scope of pediatric and child health nursing. PRACTICE IMPLICATIONS The priorities will inform future research to be directed to areas of priority for stakeholders who have often not had a say in setting the research agenda.
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Affiliation(s)
- Evalotte Mörelius
- Child and Adolescent Health Service, Nedlands, WA, Australia; School of Nursing and Midwifery, Edith Cowan University, WA, Australia.
| | - Ailsa Munns
- Child and Adolescent Health Service, Nedlands, WA, Australia; Curtin School of Nursing, Curtin University, WA, Australia
| | - Stephanie Smith
- Child and Adolescent Health Service, Nedlands, WA, Australia; School of Nursing and Midwifery, Edith Cowan University, WA, Australia
| | - Helen J Nelson
- Child and Adolescent Health Service, Nedlands, WA, Australia
| | - Anne McKenzie
- Community Engagement Telethon Kids Institute, Nedlands, WA, Australia
| | - Jade Ferullo
- Child and Adolescent Health Service, Nedlands, WA, Australia
| | - Fenella J Gill
- Child and Adolescent Health Service, Nedlands, WA, Australia; Curtin School of Nursing, Curtin University, WA, Australia
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Hoffman SC, Buczkowski AS, Mallory L, McGovern LB, Cappen SM, Douglass AS, Correia R, Longnecker L, Taylor CS, Holmes R, Poulin B, McElwain LL. Addressing Transportation Insecurity Improves Attendance at Posthospitalization Appointments. Pediatrics 2022; 149:183844. [PMID: 34972225 DOI: 10.1542/peds.2020-032862] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Transportation influences attendance at posthospitalization appointments (PHAs). In 2017, our pediatric hospital medicine group found that our patients missed 38% of their scheduled PHAs, with several being due to transportation insecurity. To address this, we implemented a quality improvement project to perform inpatient assessment of transportation insecurity and provide mitigation with the goal of improving attendance at PHAs. METHODS The process measure was the percentage of patients with completed transportation insecurity screening, and the outcome measure was PHA attendance. An interprofessional team performed plan-do-study-act cycles. These included educating staff about the significance of transportation insecurity, its assessment, and documentation; embedding a list of local transportation resources in discharge instructions and coaching families on using these resources; notifying primary care providers of families with transportation insecurity; and auditing PHA attendance. RESULTS Between July 2018 and December 2019, electronic health record documentation of transportation insecurity assessment among patients on the pediatric hospital medicine service and discharged from the hospital (n = 1731) increased from 1% to 94%, families identified with transportation insecurity increased from 1.2% to 5%, and attendance at PHAs improved for all patients (62%-81%) and for those with transportation insecurity (0%-57%). Our balance measure, proportion of discharges by 2 pm, remained steady at 53%. Plan-do-study-act cycles revealed that emphasizing PHA importance, educating staff about transportation insecurity, and helping families identify and learn to use transportation resources all contributed to improvement. CONCLUSIONS Interventions implemented during the inpatient stay to assess for and mitigate transportation insecurity led to improvement in pediatric PHA attendance.
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Affiliation(s)
- Sarah C Hoffman
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.,Department of Pediatrics, School of Medicine, Tufts University, Boston, Massachusetts
| | - Amy S Buczkowski
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.,Department of Pediatrics, School of Medicine, Tufts University, Boston, Massachusetts
| | - Leah Mallory
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.,Department of Pediatrics, School of Medicine, Tufts University, Boston, Massachusetts
| | - Lauren B McGovern
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Shannon M Cappen
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Amy S Douglass
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Russell Correia
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Lee Longnecker
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Campbell S Taylor
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Rebekah Holmes
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Brogan Poulin
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine
| | - Lorraine L McElwain
- The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.,Department of Pediatrics, School of Medicine, Tufts University, Boston, Massachusetts
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Greenfield G, Okoli O, Quezada-Yamamoto H, Blair M, Saxena S, Majeed A, Hayhoe B. Characteristics of frequently attending children in hospital emergency departments: a systematic review. BMJ Open 2021; 11:e051409. [PMID: 34663662 PMCID: PMC8523960 DOI: 10.1136/bmjopen-2021-051409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To summarise the literature on frequent attendances to hospital emergency departments (EDs) and describe sociodemographic and clinical characteristics of children who attend EDs frequently. SETTING Hospital EDs. PARTICIPANTS Children <21 years, attending hospital EDs frequently. PRIMARY OUTCOME MEASURES Outcomes measures were defined separately in each study, and were predominantly the number of ED attendances per year. RESULTS We included 21 studies representing 6 513 627 children. Between 0.3% and 75% of all paediatric ED users were frequent users. Most studies defined four or more visits per year as a 'frequent ED' usage. Children who were frequent ED users were more likely to be less than 5 years old. In the USA, patients with public insurance were more likely to be frequent attenders. Frequent ED users more likely to be frequent users of primary care and have long-term conditions; the most common diagnoses were infections and gastroenteritis. CONCLUSIONS The review included a wide range of information across various health systems, however, children who were frequent ED users have some universal characteristics in common. Policies to reduce frequent attendance might usefully focus on preschool children and supporting primary care in responding to primary care oriented conditions.
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Affiliation(s)
- Geva Greenfield
- Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Olivia Okoli
- Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Harumi Quezada-Yamamoto
- Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Mitch Blair
- Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Azeem Majeed
- Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Benedict Hayhoe
- Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Biagioli V, Pol A, Gawronski O, Carlin C, Cirulli L, Piga S, Stelitano R, Offidani C, Raucci U, Reale A, Tiozzo E, Villani A, Dall'Oglio I. Pediatric patients accessing Accident and Emergency Department (A&E) for non-urgent treatment: Why do parents take their children to the A&E? Int Emerg Nurs 2021; 58:101053. [PMID: 34520965 DOI: 10.1016/j.ienj.2021.101053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/04/2021] [Accepted: 07/20/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION About 20-30% of children access the Pediatric Accident and Emergency Department (A&E) for non-urgent health care that should normally follow other health care paths. This study aimed to investigate why parents take their children to the A&E for non-urgent visits rather than using primary care services. METHODS A one-year cross-sectional study was conducted in a large pediatric A&E in Italy. A paper-and-pencil 40-item questionnaire was administered to parents of children aged between 3 months to 6 years who accessed the A&E for non-urgent visits between July 2018 and June 2019. RESULTS Parents of 238 children completed the questionnaire (mean age = 2.6 years; male 58%). The most common symptoms were fever (n = 105; 44.1%) and skin rash (n = 63; 26.5%); symptoms usually started more than 24 h earlier (n = 163; 69.4%). Reasons for accessing the A&E for non-urgent visits included the availability of rapid medical tests (n = 71; 29.8%), deterioration of the clinical conditions after the pediatrician's visit (n = 67; 28.2%), and the perceived need for urgent care (n = 65; 27.3%). Besides, 26.6% (n = 63) of parents reported not being able to contact their pediatrician before accessing A&E. CONCLUSION Parents may need further education to distinguish between urgent and non-urgent pediatric health conditions.
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Affiliation(s)
- Valentina Biagioli
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Alessandra Pol
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Orsola Gawronski
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Claudia Carlin
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Luisa Cirulli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Simone Piga
- Bachelor for Pediatric Nursing, Sapienza University of Rome, Italy.
| | - Rocco Stelitano
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Caterina Offidani
- Paediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Umberto Raucci
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Antonino Reale
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Emanuela Tiozzo
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Alberto Villani
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - Immacolata Dall'Oglio
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
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Ravi N, Gitz KM, Burton DR, Ray KN. Pediatric non-urgent emergency department visits and prior care-seeking at primary care. BMC Health Serv Res 2021; 21:466. [PMID: 34001093 PMCID: PMC8128083 DOI: 10.1186/s12913-021-06480-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 05/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to examine how caregiver perceptions of primary care affects care-seeking prior to pediatric non-urgent ED visits. METHODS We performed a cross-sectional survey of caregivers of children presenting to a pediatric ED during weekday business hours and triaged as low acuity. We first compared caregiver sociodemographic characteristics, perceptions of primary care, and stated preference in care sites (ED vs PCP) for caregivers who had sought care from their child's PCP office versus had not sought care from their child's PCP office prior to their ED visit. We then examined odds of having sought care from their PCP office prior to their ED visit using multivariable logistic regression models sequentially including caregiver primary care perceptions and stated care site preferences along with caregiver sociodemographic characteristics. RESULTS Of 140 respondents, 64 (46%) sought care from their child's PCP office prior to presenting to the ED. In unadjusted analysis, children insured by Medicaid or CHIP, caregivers identifying as Black, and caregivers with lower educational attainment were less likely to have sought PCP care before presenting to the ED (p < 0.005, each). Caregivers who had sought PCP care were more likely to prefer their PCP relative to the ED in terms of ease of travel, cost, and wait times (p < 0.001, all). When including these stated preferences in a multivariable model, child insurance, caregiver race, and caregiver education were no longer significantly associated with odds of having sought PCP care prior to their ED visit. CONCLUSIONS Differential access to primary care may underlie observed demographic differences in non-urgent pediatric ED utilization.
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Affiliation(s)
- Nithin Ravi
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue,AOB - Suite 5400, Pittsburgh, PA, 15224, USA.
| | - Katherine M Gitz
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue,AOB - Suite 5400, Pittsburgh, PA, 15224, USA
- Children's Hospital of Los Angeles Medical Group, Los Angeles, USA
| | - Danielle R Burton
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kristin N Ray
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue,AOB - Suite 5400, Pittsburgh, PA, 15224, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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12
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Samuels‐Kalow ME, Ciccolo GE, Lin MP, Schoenfeld EM, Camargo CA. The terminology of social emergency medicine: Measuring social determinants of health, social risk, and social need. J Am Coll Emerg Physicians Open 2020; 1:852-856. [PMID: 33145531 PMCID: PMC7593464 DOI: 10.1002/emp2.12191] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 01/12/2023] Open
Abstract
Emergency medicine has increasingly focused on addressing social determinants of health (SDoH) in emergency medicine. However, efforts to standardize and evaluate measurement tools and compare results across studies have been limited by the plethora of terms (eg, SDoH, health-related social needs, social risk) and a lack of consensus regarding definitions. Specifically, the social risks of an individual may not align with the social needs of an individual, and this has ramifications for policy, research, risk stratification, and payment and for the measurement of health care quality. With the rise of social emergency medicine (SEM) as a field, there is a need for a simplified and consistent set of definitions. These definitions are important for clinicians screening in the emergency department, for health systems to understand service needs, for epidemiological tracking, and for research data sharing and harmonization. In this article, we propose a conceptual model for considering SDoH measurement and provide clear, actionable, definitions of key terms to increase consistency among clinicians, researchers, and policy makers.
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Affiliation(s)
- Margaret E. Samuels‐Kalow
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolMassachusettsUSA
| | - Gia E. Ciccolo
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolMassachusettsUSA
| | - Michelle P. Lin
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Elizabeth M. Schoenfeld
- Department of Emergency Medicine and Institute for Healthcare Delivery and Population ScienceUniversity of Massachusetts Medical School – BaystateSpringfieldMassachusettsUSA
| | - Carlos A. Camargo
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolMassachusettsUSA
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13
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Shi Q, Castillo F, Viswanathan K, Kupferman F, MacDermid JC. Low Income and Nonadherence to Health Supervision Visits Predispose Children to More Emergency Room Utilization. Glob Pediatr Health 2020; 7:2333794X20938938. [PMID: 35187205 PMCID: PMC8851101 DOI: 10.1177/2333794x20938938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 11/17/2022] Open
Abstract
Social inequity can have broad health impacts. The purpose of this study was to examine the effects of low income and nonadherence to health supervision visits on emergency room (ER) utilization in Eastern Brooklyn, New York. This study surveyed parents/guardians of children who received routine medical care at Brookdale ambulatory clinics from June 2017 to February 2018. Participants were asked to fill out a questionnaire on social demographics, food insecurity, and relocation. Electronic medical records (EMRs) were reviewed to retrieve numbers of missing health supervision and ER visit in past 12 months. Comorbidity was identified through EMR by International Classification of Diseases. Logistic regression analyses were used to examine the effects of nonadherence to health supervision visits on ER utilization when controlling for demographics, food insecurity, recent moving, and comorbidity. Among 268 participants, 56.0% reported their household income was less than $20,000 annually, 39.6% missed at least 1 health supervision visit, and 31.7% had at least 1 ER visit within the past 12 months. Younger age (adjusted odds ratio [aOR] = 0.92, 95% confidence interval [CI] = 0.86-0.97, P < .01), household income less than $20,000 (aOR = 1.86, 95% CI = 1.02-3.39), preexisting comorbidity (aOR = 2.36, 95% CI = 1.26-4.42), and nonadherence to health supervision visits (aOR = 5.83, 95% CI = 3.21-10.56) were associated with increased ER utilization. Nonadherence to health supervision visits is an independent risk factor and potentially modifiable. Evaluation and remediation should be pursued as a means of improving health outcomes of children in vulnerable circumstances.
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Affiliation(s)
- Qiyun Shi
- McMaster University, Hamilton, Ontario, Canada
- Brookdale University Hospital and Medical Center, New York, NY, USA
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