Abstract
Background Children with autism spectrum disorders (ASD) are more likely to have difficulties accessing health care compared to other children with special health care needs. National data based on parent report indicate that children with ASD are overutilizing emergency department (ED) services, but data on actual ED use has been limited to children with psychiatric diagnoses. This study examined factors associated with ED utilization (rate, urgency, and hospital admissions) among children with ASD compared to those without ASD. Methods Data from an urban, tertiary children’s hospital level 1 trauma center were examined retrospectively 2006–2009. Anderson’s model of health services utilization served as the study framework. The NYU ED algorithm was used to predict nonurgent visits. Multivariate linear and logistic regression analyses were performed on the rate, urgency, and subsequent hospital admissions of these ED visits. Results There were 115,443 children 2–21 years old, accounting for a total of 157,902 visits. The top three reasons for visiting the ED for children with and without ASD were acute upper respiratory infections, viral infections and otitis media. Children with ASD had on average 0.26 more ED visits annually than children without ASD (p < 0.01) and were 2.6 % points more likely to have nonurgent visits; p < 0.01). Their visits were also less likely to result in hospital admissions (OR 0. 61; p < 0.01). Conclusions Examination of predisposing, enabling, and reinforcing factors suggest that children with ASD were more likely to visit the ED and for nonurgent reasons.
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Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators & Centers for Disease Control and Prevention. (2014). Prevalence of autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 sites, United States, 2010. Morbidity and Mortality Weekly Report, 63, 1–21.
Kogan, M. D., Strickland, B. B., Blumberg, S. J., Singh, G. K., Perrin, J. M., & van Dyck, P. C. (2008). A national profile of the health care experiences and family impact of autism spectrum disorder among children in the United States, 2005–2006. Pediatrics, 122, e1149–e1158.
Nageswaran, S., Parish, S. L., Rose, R. A., & Grady, M. D. (2011). Do children with developmental disabilities and mental health conditions have greater difficulty in using health services than children with physical disorders? Maternal and Child Health Journal, 15, 634–641.
Phelps, K., Taylor, C., & Sanford, K. (2000). Factors associated with emergency department utilization for nonurgent pediatric problems. Archives of Family Medicine, 9, 1086–1092.
Gurney, J. G., McPheeters, M. L., & Davis, M. M. (2006). Parental report of health conditions and health care use among children with and without autism: National Survey of Children’s Health. Archives of Pediatrics and Adolescent Medicine, 160, 825–830.
Leslie, D. L., & Martin, A. (2007). Health care expenditures associated with autism spectrum disorders. Archives of Pediatrics and Adolescent Medicine, 161, 350–355.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition: DSM-5. Washington, DC: American Psychiatric Association.
Viscidi, E. W., Triche, E. W., Pescosolido, M. F., McLean, R. L., Joseph, R. M., Spence, S. J., & Morrow, E. M. (2013). Clinical characteristics of children with autism spectrum disorder and co-occurring epilepsy. PLoS ONE, 8, e67797.
Kotte, A., Joshi, G., Fried, R., Uchida, M., Spencer, A., Woodworth, K. Y., & Biederman, J. (2013). Autistic traits in children with and without ADHD. Pediatrics, 132, e612–e622.
Chiri, G., & Warfield, M. E. (2012). Unmet need and problems accessing core health care services for children with autism spectrum disorder. Maternal and Child Health Journal, 16, 1081–1091.
McCaig, L. F., & Burt, C. W. (2005). National hospital ambulatory medical care survey: 2003 emergency department summary. In Advance data from vital and health statistics, Vol. 358. Hyattsville, MD: National Center for Health Statistics.
American Academy of Pediatrics Committee on Pediatric Emergency Medicine. (2004). Overcrowding crisis in our nation’s emergency departments: Is our safety net unraveling? Pediatrics, 114, 878–888.
Institute of Medicine. (2002). Care without coverage: Too little, too late. Washington, DC: National Academy Press.
Pope, D., Fernandes, C. M., Bouthillette, F., & Etherington, J. (2000). Frequent users of the emergency department: A program to improve care and reduce visits. Canadian Medical Association Journal, 162, 1017–1020.
U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. (2012). The national survey of children with special health Care needs chartbook 2009–2010. Rockville, MD: U.S. Department of Health and Human Services.
Kalb, L., Stuart, E., Freedman, B., Zablotsky, B., & Vasa, R. (2012). Psychiatric-related emergency department visits among children with an autism spectrum disorder. Pediatric Emergency Care, 28, 1269–1276.
Ben-Issac, E., Schrager, S. M., Keefer, M., & Chen, A. Y. (2010). National profile of nonemergent pediatric emergency department visits. Pediatrics, 125, 454–459.
Peacock, G., Amendah, D., Ouyang, L., & Grosse, S. D. (2010). Autism spectrum disorders and health care expenditures: The effects of co-occurring conditions. Journal of Developmental and Behavioral Pediatrics, 33, 2–8.
Lunsky, Y., Paquette-Smith, M., Weiss, J. A., & Lee, J. (2014). Predictors of emergency service use in adolescents and adults with autism spectrum disorder living with family. Emergency Medicine Journal,. doi:10.1136/emermed-2014-204015.
Hyman, S. L., & Johnson, J. K. (2012). Autism and pediatric practice: Toward a medical home. Journal of Autism and Developmental Disorders, 42, 1156–1164.
Farmer, J. E., Clark, M. J., Mayfield, W. A., Cheak-Zamora, N., Marvin, A. R., Law, J. K., & Law, P. A. (2014). The relationship between the medical home and unmet needs for children with autism spectrum disorders. Maternal and Child Health Journal, 18, 672–680.
Cheak-Zamora, N. C., & Farmer, J. E. (2015). The impact of the medical home on access to care for children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 45, 636–644.
Lin, S. C., Margolis, B., Yu, S. M., & Adirim, T. A. (2014). The role of the medical home in emergency department use for children with developmental disabilities in the United States. Pediatric Emergency Care, 30, 534–539.
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36, 1–10.
McCusker, J., Karp, I., Durand, P., & Morin, J. (2003). Determinants of emergency department visits by older adults: A systematic review. Academic Emergency Medicine, 10, 1362–1370.
Afilalo, J., Marinovich, A., Afilalo, M., Colacone, A., Léger, R., Unger, B., & Giguère, C. (2004). Nonurgent emergency department patient characteristics and barriers to primary care. Academic Emergency Medicine, 11, 1302–1310.
Ballard, D., Price, M., Fung, V., Brand, R., Reed, M. E., Fireman, B., & Hsu, J. (2010). Validation of an algorithm for categorizing the severity of hospital emergency department visits. Medical Care, 48, 58–63.
Bekmezian, A., Chung, P. J., Cabana, M. D., Maselli, J. H., Hilton, J. F., & Hersh, A. L. (2011). Factors associated with prolonged emergency department length of stay for admitted children. Pediatric Emergency Care, 27, 110–115.
Boulet, S. L., Boyle, C. A., & Schieve, L. A. (2009). Health care use and health and functional impact of developmental disabilities among US children, 1997–2005. Archives of Pediatrics and Adolescent Medicine, 163, 19–26.
American Academy of Pediatrics, Medical Home Initiatives for Children with Special Health Care Needs Advisory Committee. (2004). Policy statement: Organizational principles to guide and define the child health care system and/or improve the health of all children. Pediatrics, 113, 1545–1547.
Brousseau, D. C., Berhholte, J., & Gorelick, M. H. (2004). The effect of prior interactions with a primary care provider on nonurgent pediatric emergency department use. Archives of Pediatrics and Adolescent Medicine, 158, 78–82.
Mahajan, P., Alpern, E. R., Grupp-Phelan, J., Chamberlain, J., Dong, L., Holubkov, R., & Pediatric Emergency Care Applied Research Network. (2009). Epidemiology of psychiatric-related visits to emergency departments in a multicenter collaborative research pediatric network. Pediatric Emergency Care, 25, 715–720.
Grupp-Phelan, J., Mahajan, P., Foltin, G. L., Jacobs, E., Tunik, M., & Sonnett, M. (2009). Pediatric Emergency Care Applied Research Network. Referral and resource use patterns for psychiatric-related visits to pediatric emergency departments. Pediatric Emergency Care, 25, 217–220.
Chun, T. H., Katz, E. R., & Duffy, S. J. (2013). Pediatrics mental health emergencies and special health care needs. Pediatric Clinics of North America, 60, 1185–1201.
Shimabukuro, T. T., Grosse, S. D., & Rice, C. (2008). Medical expenditures for children with an autism spectrum disorder in a privately insured population. Journal of Autism and Developmental Disorders, 38, 546–552.
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Alexis Deavenport-Saman and Yang Lu share first authorship.
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Deavenport-Saman, A., Lu, Y., Smith, K. et al. Do Children with Autism Overutilize the Emergency Department? Examining Visit Urgency and Subsequent Hospital Admissions. Matern Child Health J 20, 306–314 (2016). https://doi.org/10.1007/s10995-015-1830-y
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DOI: https://doi.org/10.1007/s10995-015-1830-y