Wanqing Zhang - Factors Related to Hospital Admissions after Emergency Department Visits among U.S...
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Contact Information Wanqing Zhang [email protected]July 16, 2015, 2015 Autism CARES Meeting Bethesda, MD Factors Related to Hospital Admissions after Emergency Department Visits among U.S Children with Autism Spectrum Disorder Wanqing Zhang, PhD, Kathryn L. Williams, MS, Grace Baranek, PhD, Brian Boyd, PhD, Ashley E. Mason, MS Adjusted Odds Ratio for Hospital Admissions following ED Events by Rural-Urban Residence among Children with ASD ED Visits Independent Variables OR 95% CI P value Residence location (Rural vs. Urban) 1.38 (1.15-1.64) 0.0004 Age (13-17 years vs 3-5 years) 1.24 (1.12-1.38) <.0001 Gender (Female vs. Male) 1.11 (1.02-1.21) 0.0139 Payer (Public vs. Private) 0.77 (0.72-0.83) 0.0489 Median household income quartile (Lowest vs. Highest) 0.76 (0.69-0.85) 0.0011 Multiple Chronic Conditions (Yes vs. No) 5.95 (5.54-6.39) <.0001 Hospital Region (South vs. Northeast) 1.09 (0.99-1.19) 0.0737 Hospital Teaching Status (Yes vs. No) 2.02 (1.87-2.18) <.0001 Research Objective This study investigated child and clinical characteristics associated with emergency department (ED) visits and the factors that resulted in hospital admission among U.S. children with autism spectrum disorder (ASD). 20.8% 46.2% 53.2% 32.5% 59.0% 21.9% 46.5% 35.2% 49.5% 35.3% 14.4% 28.6% Female 6-12 years old Public insurance South region Mutiple chronic conditions Areas with the lowest quartile of median household income Characteristics of Hospital Admissions following Pediatric ED Visits ASD Non-ASD 5.2% 4.3% 3.8% 3.6% 3.0% Unspecified episodic mood disorder Unspecified epilepsy Pneumonia Autistic disorder Dehydration Top Five Primary Diagnoses Resulting in a Transfer to Inpatient Hospitalizations among Children with ASD Study Design • Secondary data analysis from the Nationwide Emergency Department Sample (NEDS) • Used national estimates of reasons for ED visits that resulted in hospital admissions, by o rural-urban residence o other child/clinical variables • Applied multivariate regression analysis o Dependent variable: likelihood of hospital admissions as a result of ED visits for children with ASD o Independent variables at the individual- level: age, gender, quartile for median household income, insurance payer types, chronic condition indicator, and rural-urban residence o Independent variables at the hospital- level: hospital teaching status, hospital region Population Studied We used a cross-sectional sample of the NEDS involving 29,491 ED visits among children aged 3-17 years with ASD in 2009 and 2010, representing a total of 132,218 pediatric ED visits. Key Findings • Children with an ASD diagnosis were more likely to be transferred to inpatient hospitalizations than those without in 2009-2010 • 17.4% hospital admission for ASD group vs. only 4.7% for non-ASD group (P<.0001) • Top five primary diagnoses resulting in a transfer to inpatient hospitalizations among children with ASD included: unspecified episodic mood disorder , unspecified epilepsy, pneumonia, autistic disorder, and dehydration (see Figure 1) • After controlling for demographic and hospital/clinical characteristics, rural children with ASD were about 1.4 times more likely to be hospitalized than their urban counterparts with ASD • Children who were older, female, privately insured, with one or more chronic conditions, in the highest quartile of median household income, and in teaching hospitals were more likely to be admitted or transferred as inpatients Conclusions • Children with ASD were about 4 times more likely to be hospitalized after ED events compared to children without ASD • Hospitalizations among children with ASD were associated with age, gender, insurance type, prevalence of chronic conditions, median household income level, and hospital teaching status • Rural children with ASD had a significantly higher likelihood of being hospitalized compared to their urban counterparts • Both mood and autistic disorders were among the most common diagnoses related to hospital admissions after ED events • Pneumonia and dehydration were frequent but preventable conditions with higher prevalence among children with ASD Implications for Policy, Delivery or Practice Making essential mental health services available and providing adequate access to primary care could result in a potential avoidance of related inpatient hospitalizations for children with ASD, especially in rural areas. Figure 1 Table 1 Figure 2
Wanqing Zhang - Factors Related to Hospital Admissions after Emergency Department Visits among U.S Children with Autism Spectrum Disorder
Children with ASD were about 4 times more likely to be transferred to inpatient hospitalizations after ED events compared to children without ASD. Rural children with ASD had a significantly higher likelihood of being transferred to inpatient hospitalizations as a result of ED visits compared to their urban counterparts.
