Assessing the Relationship Between Well-Care Visit and Emergency Department Utilization Among Adolescents and Young Adults

doi:10.1016/j.jadohealth.2021.08.011

. 2022 Jan;70(1):64-69.

doi: 10.1016/j.jadohealth.2021.08.011. Epub 2021 Oct 6.

Assessing the Relationship Between Well-Care Visit and Emergency Department Utilization Among Adolescents and Young Adults

Jennifer E Holland¹, Susan E Varni², Christian D Pulcini³, Tamara D Simon⁴, Valerie S Harder⁵

Affiliations

¹ The Robert Larner, MD College of Medicine at The University of Vermont, Burlington, Vermont.
² The Robert Larner, MD College of Medicine at The University of Vermont, Burlington, Vermont; Department of Pediatrics at The University of Vermont, Burlington, Vermont.
³ The Robert Larner, MD College of Medicine at The University of Vermont, Burlington, Vermont; Department of Pediatrics at The University of Vermont, Burlington, Vermont; Department of Surgery at The University of Vermont, Burlington, Vermont.
⁴ Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.
⁵ The Robert Larner, MD College of Medicine at The University of Vermont, Burlington, Vermont; Department of Pediatrics at The University of Vermont, Burlington, Vermont; Department of Psychiatry at The University of Vermont, Burlington, Vermont. Electronic address: Valerie.Harder@uvm.edu.

PMID: 34625377
PMCID: PMC10494705
DOI: 10.1016/j.jadohealth.2021.08.011

Assessing the Relationship Between Well-Care Visit and Emergency Department Utilization Among Adolescents and Young Adults

Jennifer E Holland et al. J Adolesc Health. 2022 Jan.

. 2022 Jan;70(1):64-69.

doi: 10.1016/j.jadohealth.2021.08.011. Epub 2021 Oct 6.

Authors

Jennifer E Holland¹, Susan E Varni², Christian D Pulcini³, Tamara D Simon⁴, Valerie S Harder⁵

Affiliations

¹ The Robert Larner, MD College of Medicine at The University of Vermont, Burlington, Vermont.
² The Robert Larner, MD College of Medicine at The University of Vermont, Burlington, Vermont; Department of Pediatrics at The University of Vermont, Burlington, Vermont.
³ The Robert Larner, MD College of Medicine at The University of Vermont, Burlington, Vermont; Department of Pediatrics at The University of Vermont, Burlington, Vermont; Department of Surgery at The University of Vermont, Burlington, Vermont.
⁴ Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.
⁵ The Robert Larner, MD College of Medicine at The University of Vermont, Burlington, Vermont; Department of Pediatrics at The University of Vermont, Burlington, Vermont; Department of Psychiatry at The University of Vermont, Burlington, Vermont. Electronic address: Valerie.Harder@uvm.edu.

PMID: 34625377
PMCID: PMC10494705
DOI: 10.1016/j.jadohealth.2021.08.011

Abstract

Purpose: To investigate the association between adolescent and young adult (AYA) well-care visits and emergency department (ED) utilization.

Methods: Vermont's all-payer claims data were used to evaluate visits for 49,089 AYAs (aged 12-21 years) with a health-care claim from January 1 through December 31, 2018. We performed multiple logistic regression analyses to determine the association between well-care visits and ED utilization, investigating potential moderating effects of age, insurance type, and medical complexity.

Results: Nearly half (49%) of AYAs who engaged with the health-care system did not attend a well-care visit in 2018. AYAs who did not attend a well-care visit had 24% greater odds (95% confidence interval [CI]: 1.19-1.30) of going to the ED at least once in 2018, controlling for age, sex, insurance type, and medical complexity. Older age, female sex, Medicaid insurance, and greater medical complexity independently predicted greater ED utilization in the adjusted model. In stratified analyses, late adolescents and young adults (aged 18-21 years) who did not attend a well-care visit had 47% greater odds (95% CI: 1.37 - 1.58) of ED visits, middle adolescents (aged 15-17 years) had 9% greater odds (95% CI: 1.01-1.18), and early adolescents (aged 12-14 years) had 16% greater odds (95% CI: 1.06 - 1.26).

Conclusions: Not attending well-care visits is associated with greater ED utilization among AYAs engaged in health care. Focus on key quality performance metrics such as well-care visit attendance, especially for 18- to 21-year-olds during their transition to adult health care, may help reduce ED utilization.

Keywords: Adolescents and young adults; Emergency care; Insurance; Medical complexity; Preventive visits.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest: The authors have no disclosures to report, financial or otherwise.

Figures

**Figure 1.**
Final sample selection of adolescent and young adult population with insurance, sex, and medical claims information in 2018 in Vermont’s all-payer claims database.

See this image and copyright information in PMC

Comment in

Emergency Department Use in Adolescents and Young Adults: The Role of the Well-care Visit.
Scherr KA, Wong CA. Scherr KA, et al. J Adolesc Health. 2022 Jan;70(1):1-2. doi: 10.1016/j.jadohealth.2021.10.022. J Adolesc Health. 2022. PMID: 34930564 No abstract available.

Cited by

The profile of adolescents assisted by the emergency department of a Brazilian private tertiary hospital.
Helito AC, Fonseca RLA, Siqueira AHD, Ferrer CM, Faria GR, Morais IR, Junior JCA, Breziniscki MP, Morinaga CV. Helito AC, et al. Clinics (Sao Paulo). 2024 Sep 19;79:100502. doi: 10.1016/j.clinsp.2024.100502. eCollection 2024. Clinics (Sao Paulo). 2024. PMID: 39303461 Free PMC article.
A mobile integrated health program for the management of undifferentiated acute complaints in older adults is safe and feasible.
O'Connor L, Reznek M, Hall M, Inzerillo J, Broach JP, Boudreaux E. O'Connor L, et al. Acad Emerg Med. 2023 Nov;30(11):1110-1116. doi: 10.1111/acem.14791. Epub 2023 Aug 31. Acad Emerg Med. 2023. PMID: 37597241 Free PMC article.

References

1. Harris SK, Aalsma MC, Weitzman ER, et al. Research on Clinical preventive services for adolescents and young adults: Where are We and where do We need to Go? J Adolesc Health 2017;60:249–60. - PMC - PubMed
1. Callahan ST, Cooper WO. Changes in ambulatory health care Use during the transition to young adulthood. J Adolesc Health 2010;46:407–13. - PubMed
1. Fortuna RJ, Robbins BW, Halterman JS. Ambulatory care among young adults in the United States. Ann Intern Med 2009;151:379–85. - PubMed
1. Weiss AL, D’Angelo LJ, Rucker AC. Adolescent Use of the emergency department Instead of the primary care provider: Who, Why, and how Urgent? J Adolesc Health 2014;54:416–20. - PubMed
1. Ziv A, Boulet JR, Slap GB. Emergency department utilization by adolescents in the United States. Pediatrics 1998;101:987–94. - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

R03 HS024575/HS/AHRQ HHS/United States

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

[1] Harris SK, Aalsma MC, Weitzman ER, et al. Research on Clinical preventive services for adolescents and young adults: Where are We and where do We need to Go? J Adolesc Health 2017;60:249–60. - PMC - PubMed

[2] Harris SK, Aalsma MC, Weitzman ER, et al. Research on Clinical preventive services for adolescents and young adults: Where are We and where do We need to Go? J Adolesc Health 2017;60:249–60. - PMC - PubMed

[3] Callahan ST, Cooper WO. Changes in ambulatory health care Use during the transition to young adulthood. J Adolesc Health 2010;46:407–13. - PubMed

[4] Callahan ST, Cooper WO. Changes in ambulatory health care Use during the transition to young adulthood. J Adolesc Health 2010;46:407–13. - PubMed

[5] Fortuna RJ, Robbins BW, Halterman JS. Ambulatory care among young adults in the United States. Ann Intern Med 2009;151:379–85. - PubMed

[6] Fortuna RJ, Robbins BW, Halterman JS. Ambulatory care among young adults in the United States. Ann Intern Med 2009;151:379–85. - PubMed

[7] Weiss AL, D’Angelo LJ, Rucker AC. Adolescent Use of the emergency department Instead of the primary care provider: Who, Why, and how Urgent? J Adolesc Health 2014;54:416–20. - PubMed

[8] Weiss AL, D’Angelo LJ, Rucker AC. Adolescent Use of the emergency department Instead of the primary care provider: Who, Why, and how Urgent? J Adolesc Health 2014;54:416–20. - PubMed

[9] Ziv A, Boulet JR, Slap GB. Emergency department utilization by adolescents in the United States. Pediatrics 1998;101:987–94. - PubMed

[10] Ziv A, Boulet JR, Slap GB. Emergency department utilization by adolescents in the United States. Pediatrics 1998;101:987–94. - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Assessing the Relationship Between Well-Care Visit and Emergency Department Utilization Among Adolescents and Young Adults

Affiliations

Assessing the Relationship Between Well-Care Visit and Emergency Department Utilization Among Adolescents and Young Adults

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

Similar articles

Cited by

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Abstract

Conflict of interest statement

Figures

Comment in

Similar articles

Cited by

References

Publication types

MeSH terms

Related information

Grants and funding

LinkOut - more resources

Full Text Sources

Medical