Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Chris Kennedy
Start Date
13-5-2025 11:30 AM
End Date
13-5-2025 1:30 PM
Presentation Type
Poster Presentation
Description
Background: Children with higher social deprivation have higher emergency department (ED) utilization. The Childhood Opportunity Index (COI) is a validated multidimensional measure of community advantage which includes access to resources and healthy neighborhood factors. Educational priorities are frequently not tied to risk data.
Objective: This study aimed to identify zip codes with higher-than-expected ED utilization by diagnoses to prioritize the development of educational initiatives for hospitals, emergency medical services, pediatrician offices, and the community.
Methods: We performed a population-based study of children aged 0-17 years who presented to an ED in Kansas or Missouri in 2023 using census data via the Hospital Industry Database Institute The relationship between levels of COI and ED utilization was modeled, and inlier home zip codes (average utilizers) and high outlier zip codes (higher than average utilizers) were identified for each COI level. Rate ratios (RR) were used to quantify differences in ED rates between inlier and outlier zip codes. Prevalence and RR were calculated for each Major Diagnostic Category (MDC) and for the top 20 most common conditions within each MDC. Priority conditions were defined as those with prevalence and statistically significant RR above their respective medians.
Results: There were 2,351,413 children in 1,617 zip codes (17.3% Very Low COI, 36.8% Low COI) included. ED utilization rates decreased linearly as COI increased (p<.001). After modeling, there were 69 (25.2%) Very Low and 135 (22.6%) Low zip codes identified as high outliers of ED utilization. In Very Low and Low COI zip codes, eye, respiratory, and ear nose and throat (ENT) conditions had prevalence and RRs above their medians. Other diagnoses that met these priority criteria include: inflammation/infection of the eye, otitis media, streptococcal sore throat, and asthma.
Conclusion: Our data corroborated the established relationship between COI and ED utilization among children. Infections of the ear nose and throat, eye and asthma were common drivers in low and very low COI zip codes (see Table 1). The high frequency ED use for non-emergent diagnoses re-emphasizes and refocuses on access to care for families in low and very low COI levels. This data can be used to target educational initiatives including hospital, emergency medical services and pediatrician offices on best care practices and pediatric readiness, in addition to community education on appropriate ED visits
Included in
Higher Education and Teaching Commons, Medical Education Commons, Pediatrics Commons, Science and Mathematics Education Commons
Emergency Department Utilization for Educational Prioritization for Children by Levels of Community Advantage
Background: Children with higher social deprivation have higher emergency department (ED) utilization. The Childhood Opportunity Index (COI) is a validated multidimensional measure of community advantage which includes access to resources and healthy neighborhood factors. Educational priorities are frequently not tied to risk data.
Objective: This study aimed to identify zip codes with higher-than-expected ED utilization by diagnoses to prioritize the development of educational initiatives for hospitals, emergency medical services, pediatrician offices, and the community.
Methods: We performed a population-based study of children aged 0-17 years who presented to an ED in Kansas or Missouri in 2023 using census data via the Hospital Industry Database Institute The relationship between levels of COI and ED utilization was modeled, and inlier home zip codes (average utilizers) and high outlier zip codes (higher than average utilizers) were identified for each COI level. Rate ratios (RR) were used to quantify differences in ED rates between inlier and outlier zip codes. Prevalence and RR were calculated for each Major Diagnostic Category (MDC) and for the top 20 most common conditions within each MDC. Priority conditions were defined as those with prevalence and statistically significant RR above their respective medians.
Results: There were 2,351,413 children in 1,617 zip codes (17.3% Very Low COI, 36.8% Low COI) included. ED utilization rates decreased linearly as COI increased (p<.001). After modeling, there were 69 (25.2%) Very Low and 135 (22.6%) Low zip codes identified as high outliers of ED utilization. In Very Low and Low COI zip codes, eye, respiratory, and ear nose and throat (ENT) conditions had prevalence and RRs above their medians. Other diagnoses that met these priority criteria include: inflammation/infection of the eye, otitis media, streptococcal sore throat, and asthma.
Conclusion: Our data corroborated the established relationship between COI and ED utilization among children. Infections of the ear nose and throat, eye and asthma were common drivers in low and very low COI zip codes (see Table 1). The high frequency ED use for non-emergent diagnoses re-emphasizes and refocuses on access to care for families in low and very low COI levels. This data can be used to target educational initiatives including hospital, emergency medical services and pediatrician offices on best care practices and pediatric readiness, in addition to community education on appropriate ED visits
