Citation

Tarimala A, Singichetti B, Yi H, Huang L, Doerschuk R, Tiso M, Yang J. J. Pediatr. 2019; 206: 178-183.

Affiliation

Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, OH; The Ohio State University College of Medicine, Columbus, OH. Electronic address: Ginger.Yang@nationwidechildrens.org.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.jpeds.2018.10.021

PMID

30442410

Abstract

OBJECTIVE: To describe the rates and patterns of initial emergency department (ED) encounters and follow-up care for concussions among Medicaid-insured children before and after the 2013 enactment of Ohio concussion law. STUDY DESIGN: Using a time-series design, this study analyzed concussion claim data obtained from Partners for Kids, a pediatric accountable-care organization in Ohio. A total of 12 512 concussions and 48 238 associated claims for services between January 1, 2008, and June 30, 2017, with an initial ED encounter among Medicaid-insured children (ages 0-18 years) were analyzed. The effect of the law on the odds of follow-up care were assessed using generalized estimating equations models, adjusted for sex, age group, and residence location.

RESULTS: Of the total 12 512 concussions, 63.9% occurred in male patients, 70.1% in patients ages 10-18 years, and 65.2% in patients from urban areas. The rate of initial ED encounters for concussions increased from 2008 to 2014 (2.8 to 4.9 per 10 000 members), followed by a decrease in 2016 (4.2 per 10 000 members). A significant increase in follow-up care after the initial ED encounter was observed from pre-law to post-law (OR 1.73, 95% CI 1.61, 1.86). A shift in follow-up care was observed from radiology and ambulance services in pre-law to primary care providers in post-law.

CONCLUSIONS: The Ohio concussion law may have influenced the patterns of initial ED visit and follow-up care for concussions among Medicaid-insured children. Future studies evaluating the impact of the law should analyze the utilization patterns among children with various insurance/payment types.

Copyright © 2018 Elsevier Inc. All rights reserved.

Language: en

Keywords

epidemiology; health policy; healthcare utilization; traumatic brain injury