Emergency Care of Children with Ambulatory Care Sensitive Conditions in the United States

J Emerg Med. 2015 Nov;49(5):729-39. doi: 10.1016/j.jemermed.2015.03.001. Epub 2015 May 30.


Background: Ambulatory care sensitive (ACS) conditions are health problems that could be prevented or ameliorated with adequate access to primary care services.

Objectives: To determine the extent to which ACS conditions account for care received by children in U.S. emergency departments (EDs) and the patient charges for this care.

Methods: A retrospective, cross-sectional analysis of the 2010 Nationwide Emergency Department Sample was performed. Patients 0-19 years of age were included and visits for ACS conditions were identified. Main outcome measures were the percentage of visits for ACS conditions, regression models predicting presentation for ACS conditions based on patient demographic characteristics, and ED charges for ACS ED visits.

Results: Of almost 30 million pediatric ED visits in the United States in 2010, 13.2% were for exclusively ACS conditions. Patients with public or no insurance were 1.2 times more likely than privately insured patients to present for an ACS condition. Lower household income (adjusted odds ratio [aOR] 1.49; 95% confidence interval [CI] 1.33-1.66) and younger patient age (aOR = 2.55; 95% CI 2.41-2.69) were also predictive of an ACS ED visit. The total of charges for ACS visits was almost $3 billion, of which publicly insured patients accounted for $1.5 billion.

Conclusions: Almost one in seven U.S. pediatric ED visits may be preventable by quality primary care. Patients with public insurance and lower income are more likely than other groups to present with ACS conditions. Better access to and use of primary care services could reduce health care costs and relieve ED overcrowding.

Keywords: ambulatory care sensitive conditions; emergency medicine; health services accessibility; pediatrics.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Age Factors
  • Ambulatory Care / statistics & numerical data*
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Emergency Service, Hospital / economics*
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Hospital Charges
  • Humans
  • Income
  • Infant
  • Infant, Newborn
  • Male
  • Medicaid / statistics & numerical data
  • Medically Uninsured / statistics & numerical data
  • Medicare / statistics & numerical data
  • Primary Health Care / statistics & numerical data*
  • Retrospective Studies
  • United States
  • Young Adult