The cost of emergency care for children across differing levels of emergency department pediatric readiness

Craig D Newgard; McKenna Smith; Amber Lin; K John McConnell; Katherine E Remick; Randall S Burd; Jennifer R Marin; N Clay Mann; Marianne Gausche-Hill; Hilary A Hewes; Angela Child; Benjamin Lang; Ashley A Foster; Brandon Maughan; Jeremy D Goldhaber-Fiebert; Pediatric Readiness Study Group

doi:10.1093/haschl/qxad015

The cost of emergency care for children across differing levels of emergency department pediatric readiness

Health Aff Sch. 2023 Jun 20;1(1):qxad015. doi: 10.1093/haschl/qxad015. eCollection 2023 Jul.

Authors

Craig D Newgard¹, McKenna Smith², Amber Lin¹, K John McConnell^{1

3}, Katherine E Remick⁴, Randall S Burd⁵, Jennifer R Marin⁶, N Clay Mann², Marianne Gausche-Hill⁷, Hilary A Hewes², Angela Child², Benjamin Lang⁴, Ashley A Foster⁸, Brandon Maughan¹, Jeremy D Goldhaber-Fiebert⁹; Pediatric Readiness Study Group

Collaborators

Pediatric Readiness Study Group:
Nathan Kuppermann, Avery Nathens, Jennifer Cook, Susan Malveau, Mengtao Dai, Ran Wei, Apoorva Salvi, Brendan Carr, Ryan Mutter, Rachel Ford

Affiliations

¹ Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, United States.
² Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84132, United States.
³ Department of Emergency Medicine, Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR 97239, United States.
⁴ Departments of Pediatrics and Surgery, Dell Medical School, University of Texas at Austin, Austin, TX 78712, United States.
⁵ Division of Trauma and Burn Surgery, Center for Surgical Care, Children's National Hospital, Washington, DC 20010, United States.
⁶ Departments of Pediatrics, Emergency Medicine, and Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States.
⁷ Los Angeles County Emergency Medical Services, Harbor-UCLA Medical Center, Torrance, CA 90502, United States.
⁸ Department of Emergency Medicine, University of California San Francisco, San Francisco, CA 94143, United States.
⁹ Department of Health Policy and Center for Health Policy, Stanford Medical School and Freeman Spogli Institute, Stanford University, Stanford, CA 94305, United States.

Abstract

High emergency department (ED) pediatric readiness is associated with improved survival in children, but the cost is unknown. We evaluated the costs of emergency care for children across quartiles of ED pediatric readiness. This was a retrospective cohort study of children aged 0-17 years receiving emergency services in 747 EDs in 9 states from January 1, 2012, through December 31, 2017. We measured ED pediatric readiness using the weighted Pediatric Readiness Score (range: 0-100). The primary outcome was the total cost of acute care (ED and inpatient) in 2022 dollars, adjusted for ED case mix and hospital characteristics. A total of 15 138 599 children received emergency services, including 27.6% with injuries and 72.4% with acute medical illness. The average adjusted per-patient cost by quartile of ED pediatric readiness ranged from $991 (quartile 1) to $1064 (quartile 4) for injured children and $1104-$1217 for medical children. The resulting cost differences were $72 (95% CI: -$6 to $151) and $113 (95% CI: $20-$206), respectively. Receiving emergency care in high-readiness EDs was not associated with marked increases in the cost of delivering services.

Keywords: children; cost; emergency department pediatric readiness; emergency services.