Purpose

The aim of this study is to identify important predictors of emergency department (ED) utilization within a population of transition-aged patients empaneled within a primary care network, particularly with high-risk chronic conditions of childhood (HRC).

Methods

We analyzed cross-sectional data of patients aged 12–29 within a primary care network (n = 19,989). We used negative binomial regression modeling to identify important predictors of ED visits in the last year.

Results

Nearly 10% (n = 1,975) of the patients had one or more identified HRCs. Our final adjusted model showed that, among others, age 18–23 years (incidence rate ratio [IRR] 1.94, 95% confidence interval [CI] 1.74–2.15), presence of a high-risk condition (IRR 1.74, 95% CI 1.54–1.96]), transfer between two primary care providers in system (IRR 1.43, 95% CI 1.18–1.72), presence of care manager (IRR 2.19, 95% CI 1.68–1.72), and public insurance status (IRR 2.85, 95% CI 2.62–3.10) were all independent predictors of higher ED utilization. Conditions associated with a high incidence of ED utilization included sickle cell anemia (IRR 5.41, 95% CI 2.78–10.54), history of transplant (IRR 2.53, 95% CI 1.11–5.80), type 1 diabetes (IRR 2.12, 95% CI 1.42–3.15), and seizure disorder (IRR 2.01, 95% CI 1.61–2.51). We estimated that for each added chronic condition, the IRR increased 1.23-fold (95% CI 1.00–1.51).

Conclusions

Our results demonstrate significantly greater use of high-cost healthcare services for patients in the 18- to 23-year age group and for patients with multiple complex medical conditions. These findings prompt a call for systems-wide processes to improve the pediatric-to-adult transition process.

中文翻译：

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急诊科就诊在主要学术医疗中心的初级保健网络中增加了过渡年龄患者

目的

本研究的目的是确定初级保健网络中过渡年龄患者群体中急诊科 (ED) 利用率的重要预测因素，特别是儿童高危慢性病 (HRC)。

方法

我们分析了初级保健网络中 12-29 岁患者的横断面数据（n = 19,989）。我们使用负二项式回归模型来确定去年 ED 就诊的重要预测因素。

结果

近 10% (n = 1,975) 的患者有一个或多个已确定的 HRC。我们的最终调整模型显示，除其他外，年龄 18-23 岁（发病率比 [IRR] 1.94，95% 置信区间 [CI] 1.74-2.15），存在高风险状况（IRR 1.74，95% CI 1.54–1.96])、系统中两个初级保健提供者之间的转移 (IRR 1.43, 95% CI 1.18–1.72)、护理经理的存在 (IRR 2.19, 95% CI 1.68–1.72) 和公共保险状况 (IRR 2.85, 95% CI 2.62–3.10) 都是较高 ED 利用率的独立预测因子。与 ED 使用率高相关的条件包括镰状细胞性贫血 (IRR 5.41, 95% CI 2.78–10.54)、移植史 (IRR 2.53, 95% CI 1.11–5.80)、1 型糖尿病 (IRR 2.12, 95% CI 1.42–3.15) 和癫痫症 (IRR 2.01, 95% CI 1.61–2.51)。我们估计，每增加一种慢性病，

结论

我们的研究结果表明，对于 18 至 23 岁年龄段的患者以及患有多种复杂疾病的患者，高成本医疗保健服务的使用率显着增加。这些发现促使人们呼吁建立全系统的流程来改善儿科到成人的过渡过程。