Objectives. To describe patterns of emergency department (ED) use among Michigan children who are dual-enrolled in Medicaid and Michigan's Title V programs for children with special health care needs (CSHCN).
Methods. Individual claims and enrollment data were examined for the period January 1, 1998 to June 30, 1999. Poisson regression analysis was used to examine the rate of ED utilization for dual-enrolled CSHCN. A time-varying hazard analysis, implemented through a GEE logistic regression model, was also used to examine the impact of changes over time in age, county of residence, and other factors.
Results. CSHCN under 1 year of age, and those with qualifying diagnoses of anemia, hemophilia, asthma, epilepsy, and juvenile diabetes displayed especially high rates of ED use. Significant geographic variation in ED use remained after controlling for qualifying diagnoses, race/ethnicity, and other factors. African-Americans displayed higher rates of ED utilization than non-Hispanic whites. SSI recipients demonstrated higher utilization than other patient groups. The relationship between ED use and other expenditures is also explored.
Conclusions. Age and qualifying diagnosis were the most important factors in explaining variation in ED use among children with special health care needs. Such patterns highlight the roles of medical management and underlying health status in ED use. Significant variation by county of residence and by race/ethnicity suggests the need for future policy research.
Learning Objectives: Participants will learn the determinants of ED utilization among children with special health care needs.
Keywords: Children With Special Needs, Emergency Department/Room
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Michigan Medicaid and Title V services
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.