Insurance status and the variable management of children presenting to the emergency department with bronchiolitis.
OBJECTIVE
To determine if insurance type is associated with differences in the management of children presenting to the emergency department (ED) with bronchiolitis


METHODS
We analyzed data from a 30-center, prospective cohort study of children younger than 2 years with bronchiolitis presenting to the ED. Insurance status was defined as private, public, and no insurance.


RESULTS
Of 1450 patients, 473 (33%) had private, 928 (64%) had public, and 49 (3%) had no insurance. Multivariable analysis found that children with public insurance were less likely to receive inhaled β-agonists (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.50-0.92) or antibiotics (OR, 0.61; 95% CI, 0.42-0.89) the week before the ED visit. Children without insurance were less likely to have a primary care provider (OR, 0.15; 95% CI, 0.04-0.57) or receive laboratory testing in the ED (OR, 0.41; 95% CI, 0.19-0.88). The children's clinical presentation (eg, respiratory rate, oxygen saturation, and retractions) and ED treatments (eg, inhaled β-agonists, inhaled racemic epinephrine, systemic corticosteroids, and antibiotics) were similar. Likewise, hospital admission (multivariable OR 1.04; 95% CI, 0.45-2.42) was similar between insurance groups.


CONCLUSIONS
We noted some pre-ED and ED management differences across insurance types for children presenting to the ED with bronchiolitis. Although these variations may reflect treatments with unproven benefits, all children regardless of insurance should receive similar care. Despite these management variations, there were no differences in medications delivered in the ED or admission rate.
Damore
Dorothy
D
Division of Pediatric Emergency Medicine, New York Presbyterian Hospital/Weill Cornell Medical Center, Cornell Medical College, New York, NY, USA. damored@mail.amc.edu
Mansbach
Jonathan M
JM
Clark
Sunday
S
Ramundo
Maria
M
Camargo
Carlos A
CA
D000280:Administration, Inhalation; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D001988:Bronchiolitis / Q000188:drug therapy / Q000191:economics*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D019468:Disease Management; D004363:Drug Utilization / Q000191:economics; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D017057:Medically Uninsured; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States
D000900:Anti-Bacterial Agents; D001993:Bronchodilator Agents