Acute care utilization for ambulatory care–sensitive conditions among publicly insured children

• Published in: Academic emergency medicine 2024-04, Vol.31 (4), p.346-353
• Main Authors: Shapiro, Daniel J., Hall, Matt, Ramgopal, Sriram, Alpern, Elizabeth R., Chaudhari, Pradip P., Eltorki, Mohamed, Badaki‐Makun, Oluwakemi, Bergmann, Kelly R., Macy, Michelle L., Foster, Carolyn C., Neuman, Mark I.
• Format: Article
• Language: English
• Subjects: Ambulatory care; ambulatory care–sensitive conditions; Emergency medical care; Health services utilization; Indigent care; Medicaid; Pediatrics; utilization
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1111/acem.14867

Background Although characteristics of preventable hospitalizations for ambulatory care–sensitive conditions (ACSCs) have been described, less is known about patterns of emergency and other acute care utilization for ACSCs among children who are not hospitalized. We sought to describe patterns of utilization for ACSCs according to the initial site of care and to determine characteristics associated with seeking initial care in an acute care setting rather than in an office. A better understanding of the sequence of health care utilization for ACSCs may inform efforts to shift care for these common conditions to the medical home. Methods We performed a retrospective analysis of pediatric encounters for ACSCs between 2017 and 2019 using data from the IBM Watson MarketScan Medicaid database. The database includes insurance claims for Medicaid‐insured children in 10 anonymized states. We assessed the initial sites of care for ACSC encounters, which were defined as either acute care settings (emergency or urgent care) or office‐based settings. We used generalized estimating equations clustered on patient to identify associations between encounter characteristics and the initial site of care. Results Among 7,128,515 encounters for ACSCs, acute care settings were the initial site of care in 27.9%. Diagnoses with the greatest proportion of episodes presenting to acute care settings were urinary tract infection (52.0% of episodes) and pneumonia (44.6%). Encounters on the weekend (adjusted odds ratio [aOR] 6.30, 95% confidence interval [CI] 6.27–6.34 compared with weekday) and among children with capitated insurance (aOR 1.55, 95% CI 1.54–1.56 compared with fee for service) were associated with increased odds of seeking care first in an acute care setting. Conclusions Acute care settings are the initial sites of care for more than one in four encounters for ACSCs among publicly insured children. Expanded access to primary care on weekends may shift care for ACSCs to the medical home.