Jonathan Rodean

Urgent Care and Emergency Department Visits in the Pediatric Medicaid Population.

BACKGROUND: Urgent care (UC) is one of the fastest growing venues of health care delivery. We compared clinical and cost attributes of pediatric UC and emergency department (ED) visits that did not result in admission. METHODS: Our study examined 5 925 568 ED and UC visits of children under 19 years old in the 2010 through 2012 Marketscan Medicaid Multi-State Database. Basic demographics, diagnoses, severity, and payments were compared. Between ED and UC visits, χ2 tests were used for proportions and Wilcoxon rank-sum tests were used for continuous variables. RESULTS: The UC and ED had the same most common diagnoses. Over half the UC visits were low severity. The ED had a higher rate of return within 7 days (8.4% vs 6.9%, P < .001) and follow-up with their primary care physician (22% vs 17.2%, P < .001). Few (<1%) were admitted on return visits from the ED or UC. Payments for UC were significantly less (median

Pediatric Critical Care Resource Use by Children with Medical Complexity

76.90 vs

Psychiatric Disorders and Trends in Resource Use in Pediatric Hospitals

186.20, P < .001). This continued to hold true when comparing payments for selected diagnoses and each severity level. By extrapolating the cost savings, a national Medicaid per-year savings, if all lowest severity level visits were seen in UC, was more than

Healthcare Utilization and Spending for Constipation in Children With Versus Without Complex Chronic Conditions.

50 million. CONCLUSIONS: UC and ED Medicaid visits have similar most common diagnoses, rate of return, and admission. Severity level and payments were lower in UC. There is potential significant cost savings if lower acuity cases can be transitioned from the ED to UC.

Delayed Diagnoses in Children with Constipation: Multicenter Retrospective Cohort Study

OBJECTIVES To examine the proportionate use of critical care resources among children of differing medical complexity admitted to pediatric intensive care units (ICUs) in tertiary-care childrens hospitals. STUDY DESIGN This is a retrospective, cross-sectional study of all children (<19 years of age) admitted to a pediatric ICU between January 1, 2012, and December 31, 2013, in the Pediatric Health Information Systems database. Using the Pediatric Medical Complexity Algorithm, we assigned patients to 1 of 3 categories: no chronic disease, noncomplex chronic disease (NC-CD), or complex chronic disease (C-CD). Baseline demographics, hospital costs, and critical care resource use were stratified by these groups and summarized. RESULTS Of 136 133 children with pediatric ICU admissions, 53.0% were categorized as having C-CD. At the individual-encounter level, ICU resource use was greatest among patients with C-CD compared with children with NC-CD and no chronic disease. At the hospital level, patients with C-CD accounted for more than 75% of all examined ICU resources, including ventilation days, ICU costs, extracorporeal membrane oxygenation runs, and arterial and central venous catheters. Children with a progressive condition accounted for one-half of all ICU resources. In contrast, patients with no chronic disease and NC-CD accounted for less than one-quarter of all ICU therapies. CONCLUSION Children with medical complexity disproportionately use the majority of ICU resources in childrens hospitals. Efforts to improve quality and provide cost-effective care should focus on this population.

Comorbidities and Complications of Spinal Fusion for Scoliosis

OBJECTIVE: To describe recent, 10-year trends in pediatric hospital resource use with and without a psychiatric diagnosis and examine how these trends vary by type of psychiatric and medical diagnosis cooccurrence. METHODS: A retrospective, longitudinal cohort analysis using hospital discharge data from 33 tertiary care US children’s hospitals of patients ages 3 to 17 years from January 1, 2005 through December 31, 2014. The trends in hospital discharges, hospital days, and total aggregate costs for each psychiatric comorbid group were assessed by using multivariate generalized estimating equations. RESULTS: From 2005 to 2014, the cumulative percent growth in resource use was significantly (all P < .001) greater for children hospitalized with versus without a psychiatric diagnosis (hospitalizations: +137.7% vs +26.0%; hospital days: +92.9% vs 5.9%; and costs: +142.7% vs + 18.9%). During this time period, the most substantial growth was observed in children admitted with a medical condition who also had a cooccurring psychiatric diagnosis (hospitalizations: +160.5%; hospital days: +112.4%; costs: +156.2%). In 2014, these children accounted for 77.8% of all hospitalizations for children with a psychiatric diagnosis; their most common psychiatric diagnoses were developmental disorders (22.3%), attention-deficit/hyperactivity disorder (18.1%), and anxiety disorders (14.2%). CONCLUSIONS: The 10-year rise in pediatric hospitalizations in US children’s hospitals is 5 times greater for children with versus without a psychiatric diagnosis. Strategic planning to meet the rising demand for psychiatric care in tertiary care children’s hospitals should place high priority on the needs of children with a primary medical condition and cooccurring psychiatric disorders.

Rising Utilization of Inpatient Pediatric Asthma Pathways.

Objectives: The aim of the study was to examine the prevalence of diagnosis and treatment for constipation among children receiving Medicaid and to compare healthcare utilization and spending for constipation among children based on number of complex chronic conditions (CCCs). Methods: Retrospective cohort study of 4.9 million children ages 1 to 17 years enrolled in Medicaid from 2009 to 2011 in 10 states in the Truven Marketscan Database. Constipation was identified using International Classification of Disease, 9th revision codes for constipation (564.0x), intestinal impaction (560.3x), or encopresis (307.7). Outpatient and inpatient utilization and spending for constipation were assessed. CCC status was identified using validated methodology. Results: A total of 267,188 children (5.4%) were diagnosed with constipation. Total constipation spending was

Constipation-Related Health Care Utilization in Children Before and After Hospitalization for Constipation:

79.5 million. Outpatient constipation spending was

Characteristics of children enrolled in medicaid with high-frequency emergency department use

66.8 million (84.1%) during 406,814 visits, mean spending

Effectiveness of Pediatric Asthma Pathways for Hospitalized Children: A Multicenter, National Analysis.

120/visit. Among children with constipation, 1363 (0.5%) received inpatient treatment, accounting for