1

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

9

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: nhis@cdc.gov 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.