Influence of Medicaid managed care enrollment on emergency department utilization by children

OBJECTIVE: To explore the association between Medicaid managed care plan enrollment and emergency department (ED) utilization. DESIGN: Retrospective cohort analysis using administrative claims data. PARTICIPANTS: A total of 518 982 nondisabled children 1 to 18 years of age who were Medicaid beneficiaries in calendar year 2000. MAIN OUTCOME MEASURES: Annual visit rates per 1000 member-months and incidence rate ratios for complex and noncomplex ED visits. Medicaid beneficiaries were classified on the basis of months enrolled in managed care. Administrative claims for ED visits were classified as complex or noncomplex on the basis of procedure and diagnostic codes. Multivariate logistic regression models of the incidence rate ratios were used to compare children with varying degrees of enrollment in Medicaid man-aged care with a reference group consisting of those exclusively enrolled in Medicaid managed care. RESULTS: Overall, 22% of children receiving Medicaid made 1 or more ED visits in 2000; 77% of ED visits were for noncomplex services. Children who spent less than half of their enrolled months in managed care used complex ED services 37% more frequently (P<.001) and noncomplex services 11% more frequently (P<.001) than those exclusively enrolled in Medicaid managed care. CONCLUSIONS: Children with all of their Medicaid enrollment in managed care have the lowest ED utilization rates for complex and noncomplex services. These results suggest that reducing delays in managed care plan enrollment may be an effective strategy to reduce ED utilization for this population.     

Effect of budesonide on hospitalization rates among children with acute asthma attending paediatric emergency department:a systematic review and meta-analysis

Introduction The efficacy of inhaled budesonide for managing moderate-to-severe acute exacerbations in children is not clear.Therefore,this study aimed to evalu...     

Culture results via the internet: a novel way for communication after an emergency department visit

OBJECTIVE: To determine whether the Internet could be used to facilitate personal delivery of culture results to care givers after patient discharge from the pediatric emergency department. STUDY DESIGN: We recruited families of children who had cultures taken and were discharged home from our tertiary pediatric emergency department. Parents were given a unique ID and password to retrieve information on culture results from the study web-site. Results were posted and an e-mail was sent to the family. Access pattern to the web-site was recorded, and follow-up calls at 5 and 10 days after posting were made. RESULTS: A total of 527 families were approached; 224 were excluded. Of 303 cultures available, 24 (8%) were positive and 5 (2%) were considered to be contaminants. 186 (61%) parents accessed the Internet-system after mean 94 hours (range 1 minute to 611 hours) after posting. Of the 243 (80%) families reached for follow-up, 66 (27%) "had no time" to enter the website. CONCLUSIONS: This web-based follow-up system is valuable for negative cultures but access by parents is delayed for positive cultures. Future effort to increase awareness regarding importance of obtaining culture results is needed.     

Improving follow-up for children with asthma after an acute Emergency Department visit

OBJECTIVE: To improve follow-up with primary care providers after acute Emergency Department (ED) asthma visits for children from low-income urban families. STUDY DESIGN: A prospective, randomized, controlled trial evaluated combined telephone asthma coaching and monetary incentive. The primary outcome was asthma-planning visits with primary care providers within 15 days of index ED visits. The subjects were urban parents whose children were treated for asthma in the ED and had Medicaid or no insurance. RESULTS: We enrolled 527 parents (264 control and 263 intervention). There was a significant difference ( P < .0001) between the intervention (35.7%) and control (18.9%) groups in the proportion of children who had asthma-planning visits and decreased mean nights/days with asthma symptoms by 4.36 intervention and 3.31 control at 2 weeks. The proportions of children with asthma-planning visits and acute asthma care visits during the 16-day to 6-month period were similar for both groups. CONCLUSIONS: Telephone coaching and a monetary incentive significantly increased the proportion of low-income urban parents who brought their children for asthma-planning visits, and decreased asthma symptoms shortly after asthma ED visits. The intervention did not increase subsequent asthma-planning visits or decrease ED visits or hospitalizations.     

Smoking in parents of children with asthma and bronchiolitis in a pediatric emergency department

OBJECTIVES: To determine smoking habits, levels of nicotine-addiction, readiness to quit, and beliefs about the effects of environmental tobacco smoke (ETS) of parents of children with bronchiolitis and asthma who present to a children's emergency department (ED). DESIGN/METHODS: This was a cross-sectional prevalence study of parents or legal guardians of children with asthma or bronchiolitis presenting to a pediatric ED. RESULTS: Two hundred forty-nine parents/legal guardians comprised the study group. The mean age (+/-SD) was 30.0 (+/-8.9) years; 88% were female; 51% were nonwhite; 37% were educated beyond high school. The self-reported smoking prevalence was 41% (95% CI = 32-51). Smoking prevalence among parents of wheezing children varied according to education, income, and race, but not according to gender, age, or employment status. Of the 102 smokers in the sample, 84 (82.4%, 95% CI = 73-88) reported that they wanted to quit; 78 (76.5%, 95% CI = 68-84) stated that they wanted to quit within the next month. Forty-nine percent (95% CI = 39-59) scored above 4 on the Fagerstrom Test for Nicotine Dependence and were considered nicotine-dependent. The majority of smokers admitted to smoking around their children (66.7%, 95% CI = 57-75). Many parents knew that ETS might contribute to the development of the following illnesses: colds/upper respiratory tract infections - 77.5%, otitis media - 68.6%, pneumonia - 50%, wheezing/asthma attacks - 86.3%, and SIDS - 31.4%. CONCLUSION: The prevalence of smoking and nicotine addiction among parents of children with asthma or bronchiolitis who bring their children to a pediatric ED is high. Many parents have some knowledge about the effects of ETS, and the majority would like to quit. Future studies to help determine the best way to deliver advice to parents on ETS exposure reduction and smoking cessation are warranted.