Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC.
Acad Pediatr. 2018 Nov-Dec;18(8):952-956. doi: 10.1016/j.acap.2018.04.004. Epub 2018 Apr 16.
Pediatric constipation is common, costly, and often managed in the Emergency Department (ED). The objectives of this study were to determine the frequency of constipation-related ED visits in a large commercially insured population, the frequency of an office visit in the month before and after these visits, demographic characteristics associated with these office visits, and the ED-associated payments.
Data were extracted from the Truven MarketScan database for commercially insured children from 2012 to 2013. Data on the presence and timing of clinic visits within 30 days before and after an ED constipation visit and demographic variables were extracted. Logistic regression was used to predict an outcome of presence of a visit with independent variables of age, sex, and region of the country.
In a population of 17 million children aged 0 to 17 years, 448,440 (2.6%) were identified with constipation in at least 1 setting, with 65,163 (14.5%) having an ED visit for constipation. Of all children with a constipation-related ED visit, 45% had no office visit in the 30 days before or after the ED visit. Increasing age was associated with absence of an office visit. The median payment by insurance for an ED constipation visit was $523, the median out-of-pocket payment was $100, for a total of $623 per visit.
One in 7 children with constipation in this commercially insured population received ED care for constipation, many without an outpatient visit in the month before or after. Efforts to improve primary care utilization for this condition should be encouraged.
小儿便秘较为常见，医疗费用高昂，且常于急诊科（ED）进行诊治。本研究旨在明确在一个大型商业保险人群中，便秘相关 ED 就诊的频率，就诊前及就诊后一个月内门诊就诊的频率，与这些门诊就诊相关的人口统计学特征，以及 ED 相关的支付情况。
从 2012 年至 2013 年商业保险儿童的 Truven MarketScan 数据库中提取数据。提取 ED 便秘就诊前 30 天内和就诊后 30 天内门诊就诊的存在情况和时间以及人口统计学变量的数据。采用逻辑回归预测就诊的存在情况，自变量为年龄、性别和国家地区。
在 0 至 17 岁的 1700 万儿童中，有 448440 例（2.6%）在至少一个环境中被诊断为便秘，有 65163 例（14.5%）因便秘在 ED 就诊。所有便秘相关 ED 就诊的儿童中，45%在 ED 就诊前或后 30 天内没有门诊就诊。年龄增加与门诊就诊缺失相关。ED 便秘就诊的保险支付中位数为 523 美元，自付费用中位数为 100 美元，每次就诊总费用为 623 美元。
在该商业保险人群中，每 7 例便秘儿童中就有 1 例接受 ED 治疗，其中许多儿童在就诊前或就诊后一个月内未进行门诊就诊。应鼓励努力提高该疾病的初级保健利用率。
