Cai Peter Y, McNamara Erin R, Thaker Hatim, Estrada Carlos R, Wang Hsin-Hsiao S
Department of Urology, Boston Children's Hospital, Boston, Massachusetts.
Department of Surgery, Harvard Medical School, Boston, Massachusetts.
J Urol. 2025 Mar;213(3):333-340. doi: 10.1097/JU.0000000000004329. Epub 2024 Nov 12.
Identifying factors associated with emergency visits that could be delivered at lower cost sites may help guide population health strategies for pediatric patients with spina bifida.
Emergency department encounters (2016-2023) by patients with spina bifida (younger than 18 years) in the Pediatric Health Information System were identified. Absence of clinical and imaging charges was defined as low-value emergency visit. We used a control population of patients (younger than 18 years) with obstructive/reflux uropathy who presented for emergency department encounters (2016-2023). Mixed-effects (with repeated individual measurements as random effect) logistic regression was fitted to model odds of low-value emergency visit.
In total, we included 22,672 emergency visits by patients with spina bifida. Of these, 20.7% of emergency visits were low value vs 17.7% in controls ( < .001). Costs related to low-value emergency visits account for 3.8% of all costs for emergency visit-related encounters in patients with spina bifida. Low-value emergency visits were associated with younger age (odds ratio [OR], 1.05 [1.04-1.06] per year younger), Hispanic/Latino ethnicity (OR, 1.21 [1.06-1.39] compared with non-Hispanics), Black race (OR, 1.35 [1.16-1.58] compared with White), public insurance (OR, 1.14 [1.01-1.29] compared with private insurance), and genitourinary encounter diagnosis (OR, 1.16 [1.04-1.30]). Using a standard patient, we found that the odds of low-value emergency visit across hospitals ranged from 0.31 to 5.36.
Younger age, Hispanic/Latino ethnicity, Black and other race, public insurance, and genitourinary encounter diagnosis were associated with higher odds of low-value emergency visits in pediatric patients with spina bifida. There was wide variation across hospitals, which warrants further investigation to elucidate best practices.
识别与可在成本较低地点进行的急诊就诊相关的因素，可能有助于指导脊柱裂患儿的人群健康策略。
在儿科健康信息系统中识别出脊柱裂患者（18岁以下）在2016年至2023年期间的急诊科就诊情况。无临床和影像检查费用被定义为低价值急诊就诊。我们使用了因梗阻性/反流性泌尿系统疾病前来急诊科就诊（2016年至2023年）的患者（18岁以下）作为对照人群。采用混合效应（将重复的个体测量作为随机效应）逻辑回归来模拟低价值急诊就诊的几率。
我们总共纳入了22,672例脊柱裂患者的急诊就诊病例。其中，20.7%的急诊就诊为低价值就诊，而对照组为17.7%（P<0.001）。与低价值急诊就诊相关的费用占脊柱裂患者急诊就诊相关总费用的3.8%。低价值急诊就诊与年龄较小（每小一岁的比值比[OR]为1.05[1.04 - 1.06]）、西班牙裔/拉丁裔种族（与非西班牙裔相比，OR为1.21[1.06 - 1.39]）、黑人种族（与白人相比，OR为1.35[1.16 - 1.58]）、公共保险（与私人保险相比，OR为1.14[1.01 - 1.29]）以及泌尿生殖系统就诊诊断（OR为1.16[1.04 - 1.30]）有关。使用标准患者，我们发现各医院低价值急诊就诊的几率在0.31至5.36之间。
年龄较小、西班牙裔/拉丁裔种族、黑人和其他种族、公共保险以及泌尿生殖系统就诊诊断与脊柱裂患儿低价值急诊就诊的较高几率相关。各医院之间存在很大差异，这值得进一步调查以阐明最佳实践。
