Similarities noted in pediatric Medicaid emergency and urgent care visits

1. In Medicaid populations, the leading 3 diagnoses in the pediatric emergency department (ED) were the same as those in pediatric urgent care (UC) visits.

2. Urgent care visits were associated with significantly lower costs than emergency department visits.

Evidence Rating Level: 2 (Good)

Study Rundown: Urgent care is a growing facet of healthcare, allowing more access for the treatment of nonemergent conditions. While the majority of urgent care patients are children, few research studies exist examining the pediatric population in the urgent care setting. In the current investigation, researchers sought to provide a comparative perspective on pediatric emergency department visits versus pediatric urgent care visits. Using data from the Medicaid Multi-State Database, results showed that the top 3 reasons why children were brought into an emergency room or an urgent care were the same: “upper respiratory infection,” “fever,” and “otitis media.” In addition, results indicated that UC visits were significantly less expensive than ED visits. The exclusive inclusion of data from a Medicaid database and study completion at only 2 sites may limit generalizability to those with private insurance of self-pay. Other limitations included potential misclassification of ICD-9 or service codes, and the exclusion of higher severity levels that resulted in an admission to the hospital or death. These results suggest that proper education of patients regarding the severity of their chief complaints and appropriate setting for treatment may result in cost savings.

Click to read the study, published today in Pediatrics

Relevant Reading: No Appointment Needed: The Resurgence of Urgent Care Centers in the United States

In-Depth [retrospective cohort]: This study included 869 817 UC visits and 5 055 751 emergency department visits for children under the age of 19 that did not result in admission. Data was retrieved from 2010, 2011, and 2012 Marketscan Medicaid database, which also contains payment information for covered services. Visits at UCs and EDs were assigned a severity level between 1 and 5, with 5 being the most severe – all based on the ICD-9 code designated for that visit. UCs and EDs shared the same most common diagnoses. The UC visit frequency for the top 3 were upper respiratory infection (23.8%), otitis media (9.4%), and fever (7.1%), while the ED’s were 9.9%, 9.2%, and 5.1%, respectively. In terms of severity, 61.7% of UC vs. 43.8% of ED visits were considered low severity (p < 0.001). In addition, the ED visits had a higher rate of return within 7 days: 8.4% vs. 6.9% (p < 0.001) and a higher rate of follow-up at an office visit: 22% vs. 17.2% (p < 0.001). UC visits resulted in lower payments than ED visits: median $77 vs. $186 (p < 0.001). If all severity level 1 and 2 visits in the ED were seen in the UC, a projected total of $925 million would be saved.

Image: PD

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