Purpose

To investigate the association between adolescent and young adult (AYA) well-care visits and emergency department (ED) utilization.

Methods

Vermont's all-payer claims data were used to evaluate visits for 49,089 AYAs (aged 12-21 years) with a health-care claim from January 1 through December 31, 2018. We performed multiple logistic regression analyses to determine the association between well-care visits and ED utilization, investigating potential moderating effects of age, insurance type, and medical complexity.

Results

Nearly half (49%) of AYAs who engaged with the health-care system did not attend a well-care visit in 2018. AYAs who did not attend a well-care visit had 24% greater odds (95% confidence interval [CI]: 1.19–1.30) of going to the ED at least once in 2018, controlling for age, sex, insurance type, and medical complexity. Older age, female sex, Medicaid insurance, and greater medical complexity independently predicted greater ED utilization in the adjusted model. In stratified analyses, late adolescents and young adults (aged 18-21 years) who did not attend a well-care visit had 47% greater odds (95% CI: 1.37 - 1.58) of ED visits, middle adolescents (aged 15-17 years) had 9% greater odds (95% CI: 1.01–1.18), and early adolescents (aged 12-14 years) had 16% greater odds (95% CI: 1.06 - 1.26).

Conclusions

Not attending well-care visits is associated with greater ED utilization among AYAs engaged in health care. Focus on key quality performance metrics such as well-care visit attendance, especially for 18- to 21-year-olds during their transition to adult health care, may help reduce ED utilization.

中文翻译：

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评估青少年和年轻人的医疗就诊与急诊科利用之间的关系

目的

调查青少年和年轻人 (AYA) 就诊与急诊科 (ED) 使用率之间的关联。

方法

佛蒙特州的所有付款人索赔数据用于评估 2018 年 1 月 1 日至 12 月 31 日期间 49,089 名 AYA（12-21 岁）的医疗保健索赔就诊情况。我们进行了多重逻辑回归分析，以确定良好护理之间的关联就诊和急诊室使用情况，调查年龄、保险类型和医疗复杂性的潜在调节作用。

结果

2018 年，近一半 (49%) 参与医疗保健系统的 AYA 没有参加医疗保健就诊。未参加医疗保健就诊的 AYA 的几率要高出 24%（95% 置信区间 [CI]） ：1.19–1.30）在 2018 年至少去一次急诊室，控制年龄、性别、保险类型和医疗复杂性。在调整后的模型中，年龄较大、女性、医疗补助保险和更高的医疗复杂性独立预测了急诊室利用率的提高。在分层分析中，未参加良好护理就诊的青少年晚期和年轻人（18-21 岁）前往急诊室就诊的几率要高出 47%（95% CI：1.37 - 1.58），中期青少年（15-17 岁）岁）的几率要高出 9%（95% CI：1.01-1.18），青少年早期（12-14 岁）的几率要高出 16%（95% CI：1.06 - 1.26）。

结论

从事医疗保健的 AYA 中，不参加医疗保健就诊与急诊室利用率的提高有关。关注关键的质量绩效指标，例如护理就诊人数，特别是对于正在向成人医疗保健过渡的 18 至 21 岁的人，可能有助于减少急诊室的利用率。