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Monitoring Pediatric Emergency Room Use with the National Health Interview
Survey
Renee M. GindiDivision of Health Interview Statistics, NCHS
National Conference on Health StatisticsAugust 7, 2012
National Center for Health StatisticsCenters for Disease Control and Prevention
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Outline Pediatric emergency room (ER) use and the
Affordable Care Act (ACA) Determinants of pediatric ER use Using NHIS to examine associations with
pediatric ER use Summary and next steps
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Affordable Care Act and Pediatric ER Use
Medicaid expansion: Planning: Predicting access needs
Current concerns: Cost control Denial of payment for “unnecessary” ER use
Understanding reasons for ER visits
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Correlates of Pediatric ER Use Sociodemographic and
neighborhood factors (age, single parent, poverty, lack of parental education, urbanicity)
Health insurance Usual source of care Preventive care Timely access to and satisfaction
with provider
Unmet medical needs Poor health
PREDISPOSING
ENABLING
NEED
6
2011 NHIS Sample: 40,300 families
102,000 persons 33,00 sample adults 12,850 sample children
Methods: Study Population
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Methods: Questionnaire ContentEmergency room use: Number of ER visits for the child in the past
12 months
If at least one visit… Hospital admission for last ER visit If not admitted, reason for last ER visit
Eight reasons Can select more than one
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Methods: Questionnaire Content Age Poverty Urbanicity Insurance coverage status Usual place of care in past 12
months Preventive care visit in past 12
months Problems with accessing provider Unmet medical needs Health status Seriousness of medical problem Hospital admission
PREDISPOSING
ENABLING
NEED
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Q1 2009
Q2 Q3 Q4 Q1 2010
Q2 Q3 Q4 Q1 2011
Q2 Q3 Q40
10
20
30
Perc
ent
5-7 years
12-17 years
Percentage of children visiting the ER one or more times in the past 12 months, by age group:
U.S., 2009-2011
0-4 years22.8%
27.8%
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Percentage of children aged 0-17 using the ER, by poverty and urbanization: U.S., 2011
Poverty Urbanization0
5
10
15
20
25
3025.6
17.920.0
21.9
15.4
Perc
ent
Poor
Near poor
Not poor Within
MSAOutside of MSA
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Percentage of children aged 0-17 using the ER, by insurance coverage status: U.S., 2011
Private Medicaid/CHIP Uninsured0
5
10
15
20
25
30
14.9
24.4
13.8
Perc
ent
Insurance Coverage Status
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Percentage of children aged 0-17 using the ER, by usual place of care and receipt of preventive
care: U.S., 2011
Usual Place of Care Preventive Visit0
5
10
15
20
25
18.6 19.416.8
15.1
Perc
ent
Yes Yes
NoNo
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Percentage of children aged 0-17 using the ER, by unmet medical needs and health
status: U.S., 2011
Unmet medical needs Health Status05
1015202530354045
22.316.918.4
24.3
39.7
Perc
ent
Yes
No Excll/ Very Good
Good
Fair/Poor
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Correlates of hospital admission after ER visit in past 12 months among children aged 0-17:
U.S., 2011
Increased likelihood of admission Within MSA
(vs. outside MSA) Poor/near poor
(vs. not poor) Medicaid/CHIP or
Uninsured (vs. Privately insured)
Fair/poor health status(vs. excellent/very good)
No difference in admission
Usual place for health care
Unmet medical need Receipt of
preventive care
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Most care is at emergency roomEmergency room is closest provider
No other place to goDoctor's office not open
Lack of access to other providersArrived by ambulance
Health provider said to goProblem too serious for doctor's office
Only hospital could helpSeriousness of medical problem
0 10 20 30 40 50 60 70 80 906.6
37.7
46.1
64.4
81.2
5.7
23.5
37.2
48.3
62.9
Percentage with reason for last ER visit, among children aged 0-17 whose last visit in past 12 months
did not result in hospital admission: U.S., 2011
16
50.0
27.6
17.05.4Private
Access and SeriousnessAccess onlySeriousness onlyNeither
Percentages of children aged 0-17 with specific type of reason for ER visit, by insurance
coverage type: U.S., 2011
47.2
35.8
12.34.7
Medicaid/CHIP
Access and SeriousnessAccess onlySeriousness onlyNeither
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Summary Age, poverty, urbanicity as
expected
Medicaid/CHIP Associated with more ER use Associated with more admissions Associated with lack of access reasons
Usual place / Preventive care not as expected
Health status as expected Unmet need not as expected
PREDISPOSING
ENABLING
NEED
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Next Steps Stratified / adjusted statistical analyses
Expanded universe for “reason for visit” questions
State-based analyses
Trend analyses
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For more information please contact National Center for Health StatisticsDivision of Health Interview Statistics, National Center for Health Statistics3311 Toledo Rd, Room 2217 Hyattsville, MD 20782E-mail: [email protected] Web: http://www.cdc.gov/nchs/nhis.htmTelephone: (301) 458-4901
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EXTRA SLIDES
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Most care is at emergency roomEmergency room is closest provider
No other place to goDoctor's office not open
Lack of access to other providersArrived by ambulence
Health provider said to goProblem too serious for doctor's office
Only hospital could helpSeriousness of medical problem
0 10 20 30 40 50 60 70 80 9017.7
45.8
46.3
48
79.7
8.9
20.1
42.5
54.5
66
Source: Gindi RM, Cohen RA, Kirzinger WK. Emergency room use among adults aged 18–64: Early release of estimates from the National Health Interview Survey, January–June 2011. National Center for Health Statistics. May 2012.
Percentage with reason for last ER visit, among adults aged 18–64 whose last visit in past 12 months did not result in
hospital admission: U.S., Jan–Jun 2011
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ER visits for children under 18 years, by age group: United States, 2008-2010
2008 2009 2010 20110
5
10
15
20
25
30
3528.7 26.8 28.1
24.8
18.2 18.8 20.3
15.317.3 17.9 19.0
16.90-45-1112-17
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ER visits for children under 18 years, by age group: United States, 2010
0-4 5-11 12-1702468
1012141618
1 visit2 visits
Bloom, Cohen, and Freeman. Summary Health Statistics for U.S. Children: National Health Interview Survey, 2010.