title: Impact of Chronic Conditions on Emergency Department Visits of Children Using Medicaid.
abstract: To assess the impact of chronic conditions on children's emergency department (ED) use.
  
  
  
  Retrospective analysis of 1 850 027 ED visits in 2010 by 3 250 383 children ages 1-21 years continuously enrolled in Medicaid from 10 states included in the Truven Marketscan Medicaid Database. The main outcome was the annual ED visit rate not resulting in hospitalization per 1000 enrollees. We compared rates by enrollees' characteristics, including type and number of chronic conditions, and medical technology (eg, gastrostomy, tracheostomy), using Poisson regression. To assess chronic conditions, we used the Agency for Healthcare Research and Quality's Chronic Condition Indicator system, assigning chronic conditions with ED visit rates ≥75th percentile as having the "highest" visit rates.
  
  
  
  The overall annual ED visit rate was 569 per 1000 enrollees. As the number of the children's chronic conditions increased from 0 to ≥3, visit rates increased by 180% (from 376 to 1053 per 1000 enrollees, P < .001). Rates were 174% higher in children assisted with vs without medical technology (1546 vs 565, P < .001). Sickle cell anemia, epilepsy, and asthma were among the chronic conditions associated with the highest ED visit rates (all ≥1003 per 1000 enrollees).
  
  
  
  The highest ED visit rates resulting in discharge to home occurred in children with multiple chronic conditions, technology assistance, and specific conditions such as sickle cell anemia. Future studies should assess the preventability of ED visits in these populations and identify opportunities for reducing their ED use.
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA. Electronic address: Jay.berry@childrens.harvard.edu.
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
authors.affiliation: Children's Hospital Association, Overland Park, KS.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rodean
authors.affiliation: Children's Hospital Association, Overland Park, KS.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.affiliation: Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Alpern
authors.affiliation: Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Aronson
authors.affiliation: Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital and Research Institute, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Freedman
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI.
authors.forename: David C
authors.initials: DC
authors.lastname: Brousseau
authors.affiliation: Divisions of Hospital Medicine and Infectious, Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, and Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Harold K
authors.initials: HK
authors.lastname: Simon
authors.affiliation: Division of Pediatric Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Eyal
authors.initials: E
authors.lastname: Cohen
authors.affiliation: Departments of Pediatrics and Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Marin
authors.affiliation: Children's Health System of Texas, Dallas, TX; Department of Pediatrics, University of Texas Southwestern, Dallas, TX.
authors.forename: Rustin B
authors.initials: RB
authors.lastname: Morse
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Margaret
authors.initials: M
authors.lastname: O'Neill
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Neuman
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D015331:Cohort Studies; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006302:Health Services Research; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States
keywords: Medicaid; chronic conditions; emergency department