To investigate the association between adolescent and young adult (AYA) well-care visits and emergency department (ED) utilization.
Vermont's all-payer claims data were used to evaluate visits for 49,089 AYAs (aged 12-21 years) with a health-care claim from January 1 through December 31, 2018. We performed multiple logistic regression analyses to determine the association between well-care visits and ED utilization, investigating potential moderating effects of age, insurance type, and medical complexity.
Nearly half (49%) of AYAs who engaged with the health-care system did not attend a well-care visit in 2018. AYAs who did not attend a well-care visit had 24% greater odds (95% confidence interval [CI]: 1.19–1.30) of going to the ED at least once in 2018, controlling for age, sex, insurance type, and medical complexity. Older age, female sex, Medicaid insurance, and greater medical complexity independently predicted greater ED utilization in the adjusted model. In stratified analyses, late adolescents and young adults (aged 18-21 years) who did not attend a well-care visit had 47% greater odds (95% CI: 1.37 - 1.58) of ED visits, middle adolescents (aged 15-17 years) had 9% greater odds (95% CI: 1.01–1.18), and early adolescents (aged 12-14 years) had 16% greater odds (95% CI: 1.06 - 1.26).
Not attending well-care visits is associated with greater ED utilization among AYAs engaged in health care. Focus on key quality performance metrics such as well-care visit attendance, especially for 18- to 21-year-olds during their transition to adult health care, may help reduce ED utilization.
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Published online: October 06, 2021
Accepted: August 9, 2021
Received: January 15, 2021
Conflicts of interest: The authors have no disclosures to report, financial or otherwise.
© 2021 Society for Adolescent Health and Medicine. All rights reserved.
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- Emergency Department Use in Adolescents and Young Adults: The Role of the Well-care VisitJournal of Adolescent HealthVol. 70Issue 1
- PreviewHigh and avoidable utilization of emergency department (ED) services creates significant burdens and costs to the health care system . When compared with other populations, adolescents and young adults (AYAs) have higher utilization of emergency services. Prior studies have identified that older AYAs  and those who are publicly insured [3,4] or have medical complexity [5,6] have the highest rates of ED utilization. The higher rates of ED utilization among AYAs are juxtaposed against lower utilization of primary care services, particularly well-care visits (WCVs) .