title: Predictors of Emergency Department Utilization Among Children in Vulnerable Families.
abstract: Preventable visits to the emergency department (ED) are estimated to represent as much as 56% of overall annual ED utilization and contribute to the high cost of health care in the United States. There are more than 25 million annual pediatric ED visits.
  
  
  OBJECTIVE
  The aim of this study was to identify factors associated with high ED utilization among children in vulnerable families.
  
  
  METHODS
  The Fragile Families and Child Wellbeing Study is a longitudinal cohort of approximately 5000 vulnerable children. Data from the 9-year follow-up survey were used in this analysis. Bivariate and multivariate logistic regression analyses were performed to identify correlates with high ED utilization (≥4 visits per year).
  
  
  RESULTS
  2631 children were included in the analysis. In a multivariate model controlling for the child's sex, race, household income, and insurance status, 4 variables were significant predictors of ED utilization: history of hospitalization within the last year (odds ratio [OR], 15.97; 95% confidence interval [CI], 6.64-38.41; P < 0.001), diagnosis of asthma (OR, 2.53; 95% CI, 1.17-5.44; P = 0.02), number of child's office/clinic visits within the last year (OR, 1.22; 95% CI, 1.12-1.33; P < 0.001), and number of primary caregiver ED visits within last year (OR, 1.15; 95% CI, 1.03-1.28; P = 0.01).
  
  
  CONCLUSIONS
  History of hospitalization, outpatient visits, primary caregiver ED utilization, and diagnosis of asthma independently predict high ED utilization by 9-year-old children in fragile families. Augmented continuity of care, disease management, and caregiver education may reduce high ED utilization in this population.
authors.forename: Colin
authors.initials: C
authors.lastname: Flood
authors.forename: Karen
authors.initials: K
authors.lastname: Sheehan
authors.forename: Marie
authors.initials: M
authors.lastname: Crandall
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005190:Family; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D035862:Vulnerable Populations / Q000706:statistics & numerical data