title: Characteristics of low-severity emergency department use among CHIP enrollees.
abstract: OBJECTIVE
  To describe patient characteristics among those utilizing the emergency department (ED) for low-severity conditions (ie, conditions potentially treatable or manageable in a primary care setting).
  
  
  METHODS
  A pooled cross-sectional study of administrative claims for ED visits among enrollees in Alabama's Children's Health Insurance Program (CHIP), ALL Kids, from January 1, 1999, through December 31, 2010.
  
  
  METHODS
  Severity of visit was categorized based on primary diagnosis code using an established claims-based algorithm. Logistic regression was used to identify patient characteristics that predicted low-severity ED visits relative to high-severity visits.
  
  
  RESULTS
  Of a total of 141,709 qualifying ED visits, 97,961 (69%) were classified as low severity, 33,941 (24%) as intermediate severity, and 9807 (7%) as high severity. Based on absolute risk differences, we found that among children utilizing the ED, low-severity visits were more likely than high-severity visits among children who were noncompliant with recommended well-child care (1.2 percentage points, 95% confidence interval [CI], 0.4-1.9); children who were nonurban residents (urban vs isolated: 1.6 percentage points, 95% CI, 1.0-2.2; urban vs small rural: 1.1 percentage points, 95% CI, 0.5-1.7); children without chronic disease (10.3 percentage points, 95% CI, 9.9-10.7) and children whose ED visits were on Sunday versus weekdays (0.9 percentage point, 95% CI, 0.6-1.3), and on Saturday versus weekdays (1.2 percentage points; 95% CI, 0.8-1.6).
  
  
  CONCLUSIONS
  Our results suggest that improving access to primary care on weekends and in rural areas are potential ways to improve the efficient use of ED services.
authors: 1665 University Blvd, Rm 330, Birmingham, AL 35294. E-mail: jblackburn@uab.edu.
authors: Justin
authors: J
authors: Blackburn
authors: David J
authors: DJ
authors: Becker
authors: Bisakha
authors: B
authors: Sen
authors: Michael A
authors: MA
authors: Morrisey
authors: Cathy
authors: C
authors: Caldwell
authors: Nir
authors: N
authors: Menachemi
mesh_terms: D000293:Adolescent; D000407:Alabama / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003933:Diagnosis; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011203:Poverty; D012720:Severity of Illness Index; D013221:State Health Plans; D055815:Young Adult