Variation in Hospitalization Rates Following Emergency Department Visits in Children with Medical Complexity

Title

Variation in Hospitalization Rates Following Emergency Department Visits in Children with Medical Complexity

Creator

Coller R J; Rodean J; Linares D E; Chung P J; Pulcini C; Hall M; Alpern E; Mosquera R; Casto E; Berry J G

Publisher

Journal of Pediatrics

Date

2019

Subject

children with medical complexity; emergency department; hospitalization

Description

Objectives: To evaluate factors associated with admission from emergency department (ED) encounters for children with medical complexity (CMC) and to quantify the hospital admission rate as well as variation in adjusted hospital admission rates across EDs.Study Design: Retrospective study of 271 806 visits to 37 EDs in freestanding children's hospitals from January 1, 2014, to June 30, 2017, for patients of all ages with a complex chronic condition. Associations between patient demographic, clinical, and health services characteristics and the likelihood of hospital admission were identified using generalized linear models, which were then used to calculate adjusted hospital admission rates.Results: Hospital admission occurred with 25.7% of ED visits. Characteristics with the greatest aOR of hospitalization were ≥3 compared with 0 prior hospitalizations in 365 days (4.7; 95% CI, 4.5-4.9), ED arrival overnight compared with during workday 3.2 (95% CI, 3.1-3.3)], and ≥6 vs 0-1 chronic conditions (1.6; 95% CI, 1.5-1.6). Adjusted hospital admission rates varied significantly (P < .001) across EDs (21.1% [10th percentile]) and 30.0% [90th percentile]). Significant variation remained when excluding low-intensity ED visits, excluding hospitalizations requiring surgery and/or intensive care, or restricting the cohort to overnight ED arrival and to children with ≥3 prior hospitalizations.Conclusions: CMC are frequently admitted from the ED. Substantial variation in CMC hospital admission rates across EDs exists after case-mix adjustment.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Citation List Month

January 2020 List

Collection

Citation

Coller R J; Rodean J; Linares D E; Chung P J; Pulcini C; Hall M; Alpern E; Mosquera R; Casto E; Berry J G, “Variation in Hospitalization Rates Following Emergency Department Visits in Children with Medical Complexity,” Pediatric Palliative Care Library, accessed August 4, 2021, https://pedpalascnetlibrary.omeka.net/items/show/16859.

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