What Do Emergency Department Visit Data Say About Risk?

When Seattle Children’s Hospital researchers set out to examine how to identify social complexity risk factors in children using various state data, they hoped that pinpointing kids with notable challenges early on could lead to better health supports, helping families build resilience and addressing unmet needs.

Soon, investigators turned to data on emergency department visits, confident that the numbers might provide insights into how these populations were using the facilities and how healthcare stakeholders could better serve them.

Looking at emergency department visits, they theorized, could confirm that social complexity risk factors—like homelessness, involvement with the child welfare system, and mental health issues in their parents—were associated with adverse outcomes, says Kimberly C. Arthur, MPH, a clinical research scientist at the hospital and a co-author on the corresponding study.

The team of researchers, which included pediatricians, looked at emergency department visits that were non-urgent and didn’t result in hospital stays, homing in on issues that might have been best addressed in a primary care setting. That stood to reveal whether kids with social risk factors face an increased risk of going to the ED for non-urgent visits. Nine of the 11 risk factors, it turned out, were associated with greater emergency department use.

“You can think of interventions that can reduce emergency department use, but more importantly, because we saw that association, we know that there are issues that need to be addressed because the children likely need extra support with getting better access to care or managing a chronic condition,” Arthur notes.

The resultant study also offered a possible solution: If a primary care physician were to see a flag on a patient’s electronic medical record highlighting a child’s social complexity risk factors, then the doctor would be better positioned to take action to help the patient and family. The particular social risk factor information would not need to be disclosed in such an arrangement, according to the researchers.

But by knowing that a social risk factor exists, a primary care physician could schedule a longer appointment to allow for a more fruitful discussion. For an acute care appointment, meanwhile, a doctor could see whether a child was up to date on all necessary vaccinations and the like, a critical opportunity since these kids may not visit doctors often, according to the researchers.

Still, the data might not be enough to get such a program off the ground. It could require a significant investment of time, money, and resources for states to develop this comprehensive identification system, meaning that such a set of disparate data and point-of-care notification might remain elusive.

Arthur says collaboration between the public health sector and practices must increase regardless. “A team approach where you potentially have a care coordinator, a social worker, and a nurse or a community health worker providing support is a way to make this more doable,” she adds. “It’s not that it all has to be on the [primary care physician]. It really takes a team. Considering the constraints of a single visit, it is important to look at what those strategies are and what is learned about family situations after having a conversation in primary care.”

The study was published in the January/February 2018 issue of the journal Annals of Family Medicine.