Abstract
Purpose
To investigate the association between adolescent and young adult (AYA) well-care
visits and emergency department (ED) utilization.
Methods
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.
Results
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).
Conclusions
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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Adolescent HealthAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Research on Clinical preventive services for adolescents and young adults: Where are We and where do We need to Go?.J Adolesc Health. 2017; 60: 249-260
- Changes in ambulatory health care Use during the transition to young adulthood.J Adolesc Health. 2010; 46: 407-413
- Ambulatory care among young adults in the United States.Ann Intern Med. 2009; 151: 379-385
- Adolescent Use of the emergency department Instead of the primary care provider: Who, Why, and how Urgent?.J Adolesc Health. 2014; 54: 416-420
- Emergency department utilization by adolescents in the United States.Pediatrics. 1998; 101: 987-994
- Adolescents who Use the emergency department as their Usual Source of care.Arch Pediatr Adolesc Med. 2000; 154: 361-365
- Young adults' health care utilization and Expenditures prior to the Affordable care Act.J Adolesc Health. 2014; 54: 663-671
- Vermont all-payer ACO model annual health outcomes and quality of care report performance Year 1 (2018).Green Mountain Care Board, 2020 (Available at:)https://gmcboard.vermont.gov/payment-reform/APM/reports-and-federal-communicationsDate accessed: September 6, 2021
- Synthesis of research on patient-Centered medical homes Brings Systematic Differences into Relief.Health Aff (Millwood). 2017; 36: 500-508
- Vermont's Community-Oriented all-payer medical home model reduces Expenditures and utilization while Delivering high-quality care.Popul Health Manag. 2016; 19: 196-205
- Investing in primary care: A state-level analysis. Patient-Centered Primary Care Collaborative and the Robert Graham Center.Millbank, 2019 (Available at:)https://www.milbank.org/publications/investing-in-primary-care-a-state-level-analysis/Date accessed: September 6, 2021
- The comprehensive primary care initiative: Effects on spending, quality, patients, and Physicians.Health Aff (Millwood). 2018; 37: 890-899
- Trends in hospital emergency department visits by age and payer, 2006–2015.Agency for Healthcare Research and Quality, Rockville, MD2018 (Available at:)https://www.ahrq.gov/news/trends-hospital-emergency-visits.htmlDate accessed: September 6, 2021
- Variation in Child health care utilization by medical complexity.Matern Child Health J. 2015; 19: 40-48
- Recognition and management of medical complexity.Pediatrics. 2016; 138: e20163021
- Status Complexicus? The emergence of pediatric complex care.Pediatrics. 2018; 141: S202-S211
- Children with complex chronic conditions in inpatient hospital settings in the United States.Pediatrics. 2010; 126: 647-655
- Variation in Hospitalization rates following emergency department visits in children with medical complexity.J Pediatr. 2019; 214: 113-120.e111
- Health care Expenditures and utilization for children with Noncomplex chronic disease.Pediatrics. 2017; 140: e20170492
- Health care utilization and spending for children with Mental health conditions in Medicaid.Acad Pediatr. 2020; 20: 678-686
- Health care Use during transfer to adult care among Youth with chronic conditions.Pediatrics. 2016; 137: e20152734
- Health insurance coverage of the total population.Kaiser Family Foundation, 2019 (Available at:)https://www.kff.org/other/state-indicator/total-populationDate accessed: September 6, 2021
- Liberty Mutual Insurance Co.14-181. Supreme Court, 2016 (Available at:)https://www.supremecourt.gov/search.aspx?Search=14-181&type=SiteDate accessed: September 6, 2021
- Bright futures: Guidelines for health Suprevision of Infants, children, and adolescents. 4 edition. American Academy of Pediatrics, Elk Grove Village, IL2017
- Pediatric medical complexity Algorithm: A new method to stratify children by medical complexity.Pediatrics. 2014; 133: E1647-E1654
- Development and Validation of the pediatric medical complexity Algorithm (PMCA) version 3.0.Acad Pediatr. 2018; 18: 577-580
- Identification of emergency department visits in Medicare Administrative claims: Approaches and Implications.Acad Emerg Med. 2017; 24: 422-431
- Adolescent and young adult health in the United States in the Past decade: Little Improvement and young adults remain worse off than adolescents.J Adolesc Health. 2014; 55: 3-16
- Improvement in preventive care of young adults after the Affordable care Act: The Affordable care Act is helping.JAMA Pediatr. 2014; 168: 1101-1106
- Association between adolescent preventive care and the Role of the Affordable care Act.JAMA Pediatr. 2018; 172: 43-48
- National hospital ambulatory medical care Survey: Emergency department summary tables.Centers for Disease Control and Prevention, Atlanta, GA2017 (Available at:)https://www.cdc.gov/nchs/ahcd/web_tables.htmDate accessed: September 6, 2021
- Health reform & adolescent health.National Center for Health Reform Implementation, Washington, DC2016 (Available at:)
- Predicting low-resource-Intensity emergency department visits in children.Acad Pediatr. 2018; 18: 297-304
- Relationship between adolescent report of patient-Centered care and of quality of primary care.Acad Pediatr. 2016; 16: 770-776
- Transitions Clinical Report Authoring Group, et al. Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home.Pediatrics. 2018; 142: e20182587
- Distances to emergency department and to primary care Provider's Office affect emergency department Use in children.Acad Emerg Med. 2009; 16: 411-417
- Disparities in adolescent health and health care: Does socioeconomic status Matter?.HSR: Health Serv Res. 2003; 38: 1235-1252
- Impact of chronic conditions on emergency department visits of children using Medicaid.J Pediatr. 2017; 182: 267-274
- Change in health status and access to care in young adults with special health care needs: Results from the 2007 national Survey of adult transition and health.J Adolesc Health. 2013; 52: 413-418
- Health care system factors associated with transition Preparation in Youth with special health care needs.Popul Health Manag. 2019; 22: 63-73
- Medical complexity and pediatric emergency department and inpatient utilization.Pediatrics. 2013; 131: e559-e565
- Effect of an Enhanced medical home on Serious illness and cost of care among high-risk children with chronic illness: A Randomized Clinical Trial.JAMA. 2014; 312: 2640-2648
Article info
Publication history
Published online: October 06, 2021
Accepted:
August 9,
2021
Received:
January 15,
2021
Footnotes
Conflicts of interest: The authors have no disclosures to report, financial or otherwise.
Identification
Copyright
© 2021 Society for Adolescent Health and Medicine. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- 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 [1]. When compared with other populations, adolescents and young adults (AYAs) have higher utilization of emergency services. Prior studies have identified that older AYAs [2] 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) [7].
- Full-Text
- Preview
