Socioeconomic factors are associated with frequency of repeat emergency department visits for pediatric closed fractures

Christopher J. Dy, Leonard Lyman Stephen, Huong T. Do, Peter D. Fabricant, Robert G. Marx, Daniel W. Green

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Previous research has demonstrated both greater difficulty in obtaining follow-up appointments and increased likelihood of return visits to the emergency department (ED) for patients with government-funded insurance plans. The purpose of the current study is to determine whether socioeconomic factors, such as race and insurance type, are associated with the frequency of repeat ED visits in pediatric patients with closed fractures. Methods: A review of ED visit data over a 2-year period from a statewide hospital discharge database in New York was conducted. Discharges for patients with a unique person identifier in the database age 17 years and younger were examined for an ICD-9 diagnosis of closed upper or lower extremity fracture. Age, sex, race, and insurance type for patients with a return ED visit within 8 weeks for the same fracture diagnosis were compared with those without a return visit using standard univariate statistical tests and logistic regression analyses. Results: Of the 68,236 visits reviewed, the revisit rate was 0.85%. Patients of nonwhite or unidentified race were significantly more likely to have a revisit than white patients (OR, 1.27; P=0.006). Patients with government-funded insurance were significantly more likely to have a revisit than those without government-funded insurance (OR, 1.55; P<0.001). Patients with private insurance were significantly less likely to have a revisit than those without private insurance (OR, 0.72; P=0.001). Conclusions: Our analysis revealed that nonwhite patients are more likely to return to the ED within 8 weeks for the same fracture diagnosis. Patients with government insurance are 55% more likely to have a revisit, whereas patients with private insurance are 28% less likely to have a revisit. Our results suggest that socioeconomic disparities exist in access to orthopaedic care for closed fractures in a pediatric population. Physicians and policy makers should be mindful of these health care disparities when striving to improve access to care among patients and resource utilization in the ED. Level of evidence: Prognostic level II.

Original languageEnglish
Pages (from-to)548-551
Number of pages4
JournalJournal of Pediatric Orthopaedics
Volume34
Issue number5
DOIs
Publication statusPublished - Jan 1 2014

Fingerprint

Closed Fractures
Insurance
Hospital Emergency Service
Pediatrics
Regression Analysis
Healthcare Disparities
Databases
Patient Discharge
International Classification of Diseases
Administrative Personnel
Orthopedics
Lower Extremity
Patient Care
Appointments and Schedules
Logistic Models

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Socioeconomic factors are associated with frequency of repeat emergency department visits for pediatric closed fractures. / Dy, Christopher J.; Lyman Stephen, Leonard; Do, Huong T.; Fabricant, Peter D.; Marx, Robert G.; Green, Daniel W.

In: Journal of Pediatric Orthopaedics, Vol. 34, No. 5, 01.01.2014, p. 548-551.

Research output: Contribution to journalArticle

Dy, Christopher J. ; Lyman Stephen, Leonard ; Do, Huong T. ; Fabricant, Peter D. ; Marx, Robert G. ; Green, Daniel W. / Socioeconomic factors are associated with frequency of repeat emergency department visits for pediatric closed fractures. In: Journal of Pediatric Orthopaedics. 2014 ; Vol. 34, No. 5. pp. 548-551.
@article{6298ec201cf34c76a504dfc98ce7ddb7,
title = "Socioeconomic factors are associated with frequency of repeat emergency department visits for pediatric closed fractures",
abstract = "Background: Previous research has demonstrated both greater difficulty in obtaining follow-up appointments and increased likelihood of return visits to the emergency department (ED) for patients with government-funded insurance plans. The purpose of the current study is to determine whether socioeconomic factors, such as race and insurance type, are associated with the frequency of repeat ED visits in pediatric patients with closed fractures. Methods: A review of ED visit data over a 2-year period from a statewide hospital discharge database in New York was conducted. Discharges for patients with a unique person identifier in the database age 17 years and younger were examined for an ICD-9 diagnosis of closed upper or lower extremity fracture. Age, sex, race, and insurance type for patients with a return ED visit within 8 weeks for the same fracture diagnosis were compared with those without a return visit using standard univariate statistical tests and logistic regression analyses. Results: Of the 68,236 visits reviewed, the revisit rate was 0.85{\%}. Patients of nonwhite or unidentified race were significantly more likely to have a revisit than white patients (OR, 1.27; P=0.006). Patients with government-funded insurance were significantly more likely to have a revisit than those without government-funded insurance (OR, 1.55; P<0.001). Patients with private insurance were significantly less likely to have a revisit than those without private insurance (OR, 0.72; P=0.001). Conclusions: Our analysis revealed that nonwhite patients are more likely to return to the ED within 8 weeks for the same fracture diagnosis. Patients with government insurance are 55{\%} more likely to have a revisit, whereas patients with private insurance are 28{\%} less likely to have a revisit. Our results suggest that socioeconomic disparities exist in access to orthopaedic care for closed fractures in a pediatric population. Physicians and policy makers should be mindful of these health care disparities when striving to improve access to care among patients and resource utilization in the ED. Level of evidence: Prognostic level II.",
author = "Dy, {Christopher J.} and {Lyman Stephen}, Leonard and Do, {Huong T.} and Fabricant, {Peter D.} and Marx, {Robert G.} and Green, {Daniel W.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1097/BPO.0000000000000143",
language = "English",
volume = "34",
pages = "548--551",
journal = "Journal of Pediatric Orthopaedics",
issn = "0271-6798",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Socioeconomic factors are associated with frequency of repeat emergency department visits for pediatric closed fractures

AU - Dy, Christopher J.

AU - Lyman Stephen, Leonard

AU - Do, Huong T.

AU - Fabricant, Peter D.

AU - Marx, Robert G.

AU - Green, Daniel W.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background: Previous research has demonstrated both greater difficulty in obtaining follow-up appointments and increased likelihood of return visits to the emergency department (ED) for patients with government-funded insurance plans. The purpose of the current study is to determine whether socioeconomic factors, such as race and insurance type, are associated with the frequency of repeat ED visits in pediatric patients with closed fractures. Methods: A review of ED visit data over a 2-year period from a statewide hospital discharge database in New York was conducted. Discharges for patients with a unique person identifier in the database age 17 years and younger were examined for an ICD-9 diagnosis of closed upper or lower extremity fracture. Age, sex, race, and insurance type for patients with a return ED visit within 8 weeks for the same fracture diagnosis were compared with those without a return visit using standard univariate statistical tests and logistic regression analyses. Results: Of the 68,236 visits reviewed, the revisit rate was 0.85%. Patients of nonwhite or unidentified race were significantly more likely to have a revisit than white patients (OR, 1.27; P=0.006). Patients with government-funded insurance were significantly more likely to have a revisit than those without government-funded insurance (OR, 1.55; P<0.001). Patients with private insurance were significantly less likely to have a revisit than those without private insurance (OR, 0.72; P=0.001). Conclusions: Our analysis revealed that nonwhite patients are more likely to return to the ED within 8 weeks for the same fracture diagnosis. Patients with government insurance are 55% more likely to have a revisit, whereas patients with private insurance are 28% less likely to have a revisit. Our results suggest that socioeconomic disparities exist in access to orthopaedic care for closed fractures in a pediatric population. Physicians and policy makers should be mindful of these health care disparities when striving to improve access to care among patients and resource utilization in the ED. Level of evidence: Prognostic level II.

AB - Background: Previous research has demonstrated both greater difficulty in obtaining follow-up appointments and increased likelihood of return visits to the emergency department (ED) for patients with government-funded insurance plans. The purpose of the current study is to determine whether socioeconomic factors, such as race and insurance type, are associated with the frequency of repeat ED visits in pediatric patients with closed fractures. Methods: A review of ED visit data over a 2-year period from a statewide hospital discharge database in New York was conducted. Discharges for patients with a unique person identifier in the database age 17 years and younger were examined for an ICD-9 diagnosis of closed upper or lower extremity fracture. Age, sex, race, and insurance type for patients with a return ED visit within 8 weeks for the same fracture diagnosis were compared with those without a return visit using standard univariate statistical tests and logistic regression analyses. Results: Of the 68,236 visits reviewed, the revisit rate was 0.85%. Patients of nonwhite or unidentified race were significantly more likely to have a revisit than white patients (OR, 1.27; P=0.006). Patients with government-funded insurance were significantly more likely to have a revisit than those without government-funded insurance (OR, 1.55; P<0.001). Patients with private insurance were significantly less likely to have a revisit than those without private insurance (OR, 0.72; P=0.001). Conclusions: Our analysis revealed that nonwhite patients are more likely to return to the ED within 8 weeks for the same fracture diagnosis. Patients with government insurance are 55% more likely to have a revisit, whereas patients with private insurance are 28% less likely to have a revisit. Our results suggest that socioeconomic disparities exist in access to orthopaedic care for closed fractures in a pediatric population. Physicians and policy makers should be mindful of these health care disparities when striving to improve access to care among patients and resource utilization in the ED. Level of evidence: Prognostic level II.

UR - http://www.scopus.com/inward/record.url?scp=84902292844&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84902292844&partnerID=8YFLogxK

U2 - 10.1097/BPO.0000000000000143

DO - 10.1097/BPO.0000000000000143

M3 - Article

C2 - 24590328

AN - SCOPUS:84902292844

VL - 34

SP - 548

EP - 551

JO - Journal of Pediatric Orthopaedics

JF - Journal of Pediatric Orthopaedics

SN - 0271-6798

IS - 5

ER -