Home About us Contact
|
Home About us Contact | ||
|
|
||
Pediatric Visits (pediatric + visit)
Selected AbstractsTrends in Charges and Payments for Nonhospitalized Emergency Department Pediatric Visits, 1996,2003ACADEMIC EMERGENCY MEDICINE, Issue 4 2008Renee Y. Hsia MD Abstract Objectives:, To compare charges and payments for outpatient pediatric emergency visits across payer groups to provide information on reimbursement trends. Methods:, Total charges and payments for emergency department (ED) visits Medicaid/State Children's Health Insurance Program (SCHIP), privately insured, and uninsured pediatric patients from 1996 to 2003 using data from the Medical Expenditure Panel Survey. Average charges per visit and average payments per visit were also tracked, using regression analysis to adjust for changes in patient characteristics. Results:, While charges for pediatric ED visits rose over time, payments did not keep pace. This led to a decrease in reimbursement rates from 63% in 1996 to 48% in 2003. For all years, Medicaid/SCHIP visits had the lowest reimbursement rates, reaching 35% in 2003. The proportion of visits from children insured by Medicaid/SCHIP also increased over the period examined. In 2003, after adjustment, charges were $792 per visit from children covered by Medicaid/SCHIP, $913 for visits from uninsured children, and $952 for visits from privately insured children. Conclusions:, Reimbursements for outpatient ED visits in the pediatric population have decreased from the period of 1996 to 2003 in all payer groups: public (Medicaid/SCHIP), private, and the uninsured. Medicaid/SCHIP has consistently paid less per visit than the privately insured and the uninsured. Further research on the effects of these declining reimbursements on the financial viability of ED services for children is warranted. [source] A System for Grouping Presenting Complaints: The Pediatric Emergency Reason for Visit ClustersACADEMIC EMERGENCY MEDICINE, Issue 8 2005MSCE, Marc H. Gorelick MD Abstract Objectives: To develop a set of chief complaint groupings for pediatric emergency department (ED) visits that is comprehensive, parsimonious, clinically sensible, and evidence-based. Methods: Investigators derived candidate chief complaint clusters and ranked them a priori into three perceived severity categories. Pediatric visits were extracted from the National Hospital Ambulatory Medical Care Survey (NHAMCS); data for years 1998 and 2000 (n= 13,186) were used for derivation and data for year 1999 (n= 5,365) were used for validation. Visits were assigned to clusters based on the recorded complaints; clusters were combined to ensure adequate numbers for analysis (minimum n= 20), and the clusters were reviewed for clinical sensibility. Resource utilization was categorized in three levels: routine (examination only), ED treatment (tests or therapy in the ED but not admitted), and admission. Area under the receiver-operating characteristic (ROC) curve (AUC) was used to demonstrate the discriminative ability of the clusters in predicting resource use. Results: There were 463 unique complaints in the derivation database; 95 (20%) had a single associated visit. Fifty-two clusters were generated; only 2.4% of complaints were classified as other. The eight most common clusters encompassed 52% of the visits. The top five were fever (11%), extremity pain/injury, vomiting, cough, and trauma (unspecified). Complaint clusters were associated with actual resource utilization: for routine care, the AUC was 0.73 (0.74 in the validation set), and for admission, the AUC was 0.77 (0.74 in the validation set). Both resource utilization and triage classification increased with increased expert severity ranking (test for trend, p < 0.001). Conclusions: The proposed Pediatric Emergency Reason for Visit Cluster (PERC) system is a comprehensive yet parsimonious, clinically sensible means of categorizing pediatric ED complaints. The PERC system's association with measures of acuity and resource utilization makes it a potentially useful tool in epidemiologic and health services research. [source] The Effects of a Physician Slowdown on Emergency Department Volume and TreatmentACADEMIC EMERGENCY MEDICINE, Issue 11 2006Brian Walsh MD Objectives In February 2003, many physicians in New Jersey participated in a work slowdown to publicize large increases in malpractice premiums and generate support for legislative reform. It was anticipated that the community physician slowdown (hereafter referred to as "slowdown") would increase emergency department (ED) visits. The authors' goal was to help others prepare for anticipated increases in ED volumes by describing the preparatory staffing changes made and quantifying increases in ED volume. Methods This was a retrospective cohort study performed at a New Jersey suburban teaching hospital with 70,000 annual visits. Consecutive patients seen by emergency physicians were enrolled. The authors extracted patient visit data from the computerized tracking system and analyzed hours worked by personnel, patient volumes, admission rates, and patient throughput times. Variables from each day of the slowdown with baseline values for the same day of the week for the four weeks before and after the slowdown were compared. A Bonferroni correction was used, with p < 0.01 considered statistically significant. Results Total patient volume increased 79% from baseline (95% confidence interval [CI] = 20% to 137%). Pediatric volume increased 223% (95% CI = 171% to 274%). Overall admission rate decreased 29% compared with baseline (95% CI = 8% to 51%). Patient throughput times did not change significantly. Similar results for these variables were found for the second through fourth days of the slowdown. Conclusions Emergency department visits, especially pediatric visits, increased markedly during the community physician slowdown. Anticipatory increases in staffing effectively prevented increased throughput times. [source] Sleep-Disordered Breathing in Children: Survey of Current PracticeTHE LARYNGOSCOPE, Issue 6 2006Ron B. Mitchell MD Abstract Objectives: The American Academy of Pediatrics recommends objective testing with polysomnography (PSG) before adenotonsillectomy for sleep-disordered breathing (SDB) in children. Several studies have also shown that a clinical diagnosis correlates poorly with the presence or severity of SDB as confirmed by PSG. The purpose of this study was to examine surgical practice patterns among members of the American Society of Pediatric Otolaryngologists (ASPO). Methods: A questionnaire was sent electronically to all members of ASPO asking about demographics, PSG facilities, and pre- and postoperative management of children with SDB. Results: A total of 245 questionnaires were sent, and 105 (43%) were completed. The results of the survey show that up to 50% of pediatric visits in individual practices were for SDB. Only 10% of children who underwent adenotonsillectomy had PSG, and the most common reason to request it was doubt about diagnosis. The average wait for PSG was 3 to 6 weeks. Preoperative PSG was routinely requested in children under 1 year of age and children with morbid obesity, craniofacial abnormalities, or neuromuscular disease. The majority of pediatric otolaryngologists proceeded with an adenotonsillectomy in symptomatic children with normal PSG findings. Postoperative PSG was requested in less than 5% of children. Approximately 20% of children who underwent adenotonsillectomy for suspected SDB were observed overnight in hospital. Conclusions: A majority of respondents from this survey rely on a clinical diagnosis rather than PSG to recommend an adenotonsillectomy for SDB in children. PSG was generally used when the diagnosis was in doubt. [source] Neuroimaging for Pediatric Head Trauma: Do Patient and Hospital Characteristics Influence Who Gets Imaged?ACADEMIC EMERGENCY MEDICINE, Issue 7 2010Rebekah Mannix MD ACADEMIC EMERGENCY MEDICINE 2010; 17:694,700 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, The objective was to identify patient, provider, and hospital characteristics associated with the use of neuroimaging in the evaluation of head trauma in children. Methods:, This was a cross-sectional study of children (,19 years of age) with head injuries from the National Hospital Ambulatory Medical Care Survey (NHAMCS) collected by the National Center for Health Statistics. NHAMCS collects data on approximately 25,000 visits annually to 600 randomly selected hospital emergency and outpatient departments. This study examined visits to U.S. emergency departments (EDs) between 2002 and 2006. Multivariable logistic regression was used to analyze characteristics associated with neuroimaging in children with head injuries. Results:, There were 50,835 pediatric visits in the 5-year sample, of which 1,256 (2.5%, 95% confidence interval [CI] = 2.2% to 2.7%) were for head injury. Among these, 39% (95% CI = 34% to 43%) underwent evaluation with neuroimaging. In multivariable analyses, factors associated with neuroimaging included white race (odds ratio [OR] = 1.5, 95% CI = 1.02 to 2.1), older age (OR = 1.3, 95% CI = 1.1 to 1.5), presentation to a general hospital (vs. a pediatric hospital, OR = 2.4, 95% CI = 1.1 to 5.3), more emergent triage status (OR = 1.4, 95% CI = 1.1 to 1.8), admission or transfer (OR = 2.7, 95% CI = 1.4 to 5.3), and treatment by an attending physician (OR = 2.0, 95% CI = 1.1 to 3.7). The effect of race was mitigated at the pediatric hospitals compared to at the general hospitals (p < 0.001). Conclusions:, In this study, patient race, age, and hospital-specific characteristics were associated with the frequency of neuroimaging in the evaluation of children with closed head injuries. Based on these results, focusing quality improvement initiatives on physicians at general hospitals may be an effective approach to decreasing rates of neuroimaging after pediatric head trauma. [source] | ||||||||||