Patient-related Factors Associated with Potentially Unnecessary Transfers for Pediatric Patients with Asthma: A Retrospective Cohort Study.

IF 1.8 3区 医学 Q2 EMERGENCY MEDICINE Western Journal of Emergency Medicine Pub Date : 2024-05-01 DOI:10.5811/westjem.18399
Gregory A Peters, Rebecca E Cash, Scott A Goldberg, Jingya Gao, Lily M Kolb, Carlos A Camargo
{"title":"Patient-related Factors Associated with Potentially Unnecessary Transfers for Pediatric Patients with Asthma: A Retrospective Cohort Study.","authors":"Gregory A Peters, Rebecca E Cash, Scott A Goldberg, Jingya Gao, Lily M Kolb, Carlos A Camargo","doi":"10.5811/westjem.18399","DOIUrl":null,"url":null,"abstract":"<p><strong>Background/objective: </strong>Asthma is a common chronic medical condition among children and the most common diagnosis associated with interfacility transports for pediatric patients. As many as 40% of pediatric transfers may be unnecessary, resulting in potential delays in care and unnecessary costs. Our objective was to identify the patient-related factors associated with potentially unnecessary transfers for pediatric patients with asthma.</p><p><strong>Methods: </strong>We used patient care data from the California Department of Health Care Access and Information patient discharge and emergency department (ED) datasets to capture ED visits where a pediatric patient (age 2-17 years) presented with asthma and was transferred to another ED or acute care hospital. The outcome of interest was a potentially unnecessary transfer, defined as a visit where length of stay after transfer was <24 hours and no advanced services were used, such as respiratory therapy or critical care. Patient-related characteristics were extracted, including age, gender, race/ethnicity, primary language, insurance status, and clinical characteristics. First, we used descriptive statistics to compare necessary vs unnecessary transfers. Second, we used generalized estimating equations accounting for clustering by ED to estimate odds ratios (OR) and identify factors associated with potentially unnecessary transfers.</p><p><strong>Results: </strong>A total of 4,233 pediatric ED patients were transferred with a diagnosis of asthma, including 461 (11%) transfers that met criteria as potentially unnecessary. Median age was 12 years (interquartile range 7-15), and 46% were female. Factors associated with increased odds of potentially unnecessary transfer while controlling for key factors included younger age (eg, 2-5 years, OR 2.0, 95% confidence interval [CI] 1.4-2.9), male gender (OR 1.4, 95% CI 1.1-1.7), and Hispanic ethnicity (OR 1.6, 95% CI 1.2-2.1), while multiple hospitalizations for asthma per year was associated with decreased odds (OR 0.2, 95% CI 0.1-0.4).</p><p><strong>Conclusion: </strong>Several patient-related factors were associated with increased or decreased odds of potentially unnecessary transfers among pediatric patients presenting to the ED with asthma. These factors can be considered in future work to better understand, predict, and reduce unnecessary transfers and their negative consequences.</p>","PeriodicalId":23682,"journal":{"name":"Western Journal of Emergency Medicine","volume":"25 3","pages":"407-414"},"PeriodicalIF":1.8000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11112663/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Western Journal of Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5811/westjem.18399","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
引用次数: 0

Abstract

Background/objective: Asthma is a common chronic medical condition among children and the most common diagnosis associated with interfacility transports for pediatric patients. As many as 40% of pediatric transfers may be unnecessary, resulting in potential delays in care and unnecessary costs. Our objective was to identify the patient-related factors associated with potentially unnecessary transfers for pediatric patients with asthma.

Methods: We used patient care data from the California Department of Health Care Access and Information patient discharge and emergency department (ED) datasets to capture ED visits where a pediatric patient (age 2-17 years) presented with asthma and was transferred to another ED or acute care hospital. The outcome of interest was a potentially unnecessary transfer, defined as a visit where length of stay after transfer was <24 hours and no advanced services were used, such as respiratory therapy or critical care. Patient-related characteristics were extracted, including age, gender, race/ethnicity, primary language, insurance status, and clinical characteristics. First, we used descriptive statistics to compare necessary vs unnecessary transfers. Second, we used generalized estimating equations accounting for clustering by ED to estimate odds ratios (OR) and identify factors associated with potentially unnecessary transfers.

Results: A total of 4,233 pediatric ED patients were transferred with a diagnosis of asthma, including 461 (11%) transfers that met criteria as potentially unnecessary. Median age was 12 years (interquartile range 7-15), and 46% were female. Factors associated with increased odds of potentially unnecessary transfer while controlling for key factors included younger age (eg, 2-5 years, OR 2.0, 95% confidence interval [CI] 1.4-2.9), male gender (OR 1.4, 95% CI 1.1-1.7), and Hispanic ethnicity (OR 1.6, 95% CI 1.2-2.1), while multiple hospitalizations for asthma per year was associated with decreased odds (OR 0.2, 95% CI 0.1-0.4).

Conclusion: Several patient-related factors were associated with increased or decreased odds of potentially unnecessary transfers among pediatric patients presenting to the ED with asthma. These factors can be considered in future work to better understand, predict, and reduce unnecessary transfers and their negative consequences.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
与儿科哮喘患者潜在不必要转院相关的患者相关因素:一项回顾性队列研究。
背景/目的:哮喘是儿童常见的慢性疾病,也是儿科病人在医院间转运时最常见的诊断。多达 40% 的儿科转运可能是不必要的,从而导致潜在的护理延误和不必要的费用。我们的目的是确定与儿科哮喘患者潜在不必要转院相关的患者相关因素:我们使用了来自加利福尼亚州卫生保健获取和信息部患者出院和急诊科(ED)数据集的患者护理数据,以捕捉儿科患者(2-17 岁)因哮喘而被转往其他急诊科或急症医院的急诊就诊情况。我们关注的结果是潜在的不必要转院,即转院后住院时间长的就诊结果:共有 4233 名诊断为哮喘的儿科急诊患者转院,其中 461 人(11%)符合潜在不必要转院的标准。中位年龄为 12 岁(四分位距为 7-15 岁),46% 为女性。在控制关键因素的情况下,与潜在不必要转院几率增加相关的因素包括年龄较小(例如,2-5 岁,OR 2.0,95% 置信区间 [CI] 1.4-2.9)、男性(OR 1.4,95% CI 1.1-1.7)和西班牙裔(OR 1.6,95% CI 1.2-2.1),而每年因哮喘多次住院与几率降低相关(OR 0.2,95% CI 0.1-0.4):结论:在因哮喘而到急诊室就诊的儿童患者中,一些与患者相关的因素与潜在不必要转院几率的增减有关。在今后的工作中可以考虑这些因素,以便更好地了解、预测和减少不必要的转院及其负面影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
Western Journal of Emergency Medicine
Western Journal of Emergency Medicine Medicine-Emergency Medicine
CiteScore
5.30
自引率
3.20%
发文量
125
审稿时长
16 weeks
期刊介绍: WestJEM focuses on how the systems and delivery of emergency care affects health, health disparities, and health outcomes in communities and populations worldwide, including the impact of social conditions on the composition of patients seeking care in emergency departments.
期刊最新文献
Impact of Prehospital Ultrasound Training on Simulated Paramedic Clinical Decision-Making. Interfacility Patient Transfers During COVID-19 Pandemic: Mixed-Methods Study. Making A Difference: Launching a Multimodal, Resident-Run Social Emergency Medicine Program. Methadone Initiation in the Emergency Department for Opioid Use Disorder. Neutrophil-to-Lymphocyte Ratio Predicts Sepsis in Adult Patients Meeting Two or More Systemic Inflammatory Response Syndrome Criteria.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1