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Abstract
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High 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]]. Policymakers have long focused on increasing rates of WCVs, in part to reduce avoidable costs, such as those incurred in expensive ED visits [8, 9, 10]. To date, limited evidence has quantified the relationship between WCVs and ED visits for AYAs.
Holland et al. explore the relationship between WCVs and ED visits for 49,089 AYAs (aged 12–21 years) who sought care in 2018 using Vermont's all-payer claims data [[11]]. Overall, approximately half (49%) of AYAs had a WCV, and 25% of AYAs had at least one ED visit during the year. AYAs who did not attend a WCV had 24% greater odds of going to the ED at least once during the year. Between the two groups, there was an absolute increase of 7.6% in AYAs who experienced the ED visit: 21.4% of patients who attended a WCV received care in the ED, whereas 29.0% of individuals who did not have a WCV received care in the ED. AYAs with the greatest odds of ED utilization in the adjusted model were older, female, Medicaid-insured, and with medical complexity. The authors propose that policies focused on increasing WCVs may help to decrease ED utilization among AYAs.
As Holland et al. acknowledge, the analyses identified an association between WCVs and ED visits for AYAs, but conclusions regarding causality or potential mechanisms cannot be made without additional data. ED visits for communicable diseases versus exacerbations of chronic disease versus accidents or injuries would suggest different mechanisms by which WCVs might decrease utilization. A strong link to a medical home through regular WCVs, for example, could lead to earlier identification and treatment for common conditions that can escalate to emergency care if left unmanaged, such as asthma, sexually transmitted infections, or depression. Preventive counseling in WCVs could decrease risky behaviors that can lead AYAs to requiring ED-level care, such as car accidents associated with substance use or texting while driving...
Language: en |