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Leaving the emergency department without complete care: disparities in American Indian children

BACKGROUND: Children who leave the emergency department (ED) without complete evaluation or care (LWCET) have poorer outcomes in general. Previous studies have found that American Indian (AI) children have higher rates of LWCET than other racial or ethnic groups. Therefore, this study aims to examin...

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Autores principales: Weber, Tess L., Ziegler, Katherine M., Kharbanda, Anupam B., Payne, Nathaniel R., Birger, Chad, Puumala, Susan E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894126/
https://www.ncbi.nlm.nih.gov/pubmed/29636036
http://dx.doi.org/10.1186/s12913-018-3092-z
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author Weber, Tess L.
Ziegler, Katherine M.
Kharbanda, Anupam B.
Payne, Nathaniel R.
Birger, Chad
Puumala, Susan E.
author_facet Weber, Tess L.
Ziegler, Katherine M.
Kharbanda, Anupam B.
Payne, Nathaniel R.
Birger, Chad
Puumala, Susan E.
author_sort Weber, Tess L.
collection PubMed
description BACKGROUND: Children who leave the emergency department (ED) without complete evaluation or care (LWCET) have poorer outcomes in general. Previous studies have found that American Indian (AI) children have higher rates of LWCET than other racial or ethnic groups. Therefore, this study aims to examine LWCET in AI children by exploring differences by ED location and utilization patterns. METHODS: This is a retrospective cohort study of five EDs in the upper Midwest between June 2011 and May 2012. We included all visits by children aged 0–17 who identified as African American (AA), AI or White. Logistic regression was used to determine differences in LWCET by race and ED location controlling for other possible confounding factors including sex, age, insurance type, triage level, distance from ED, timing of visit, and ED activity level. RESULTS: LWCET occurred in 1.73% of 68,461 visits made by 47,228 children. The multivariate model revealed that AIs were more likely to LWCET compared to White children (Odds Ratio (OR) = 1.62, 95% Confidence Interval (CI) = 1.30–2.03). There was no significant difference in LWCET between AA and White children. Other factors significantly associated with LWCET included triage level, distance from the ED, timing of visit, and ED activity level. CONCLUSION: Our results show that AI children have higher rates of LWCET compared to White children; this association is different from other racial minority groups. There are likely complex factors affecting LWCET in AI children throughout the upper Midwest, which necessitates further exploration.
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spelling pubmed-58941262018-04-12 Leaving the emergency department without complete care: disparities in American Indian children Weber, Tess L. Ziegler, Katherine M. Kharbanda, Anupam B. Payne, Nathaniel R. Birger, Chad Puumala, Susan E. BMC Health Serv Res Research Article BACKGROUND: Children who leave the emergency department (ED) without complete evaluation or care (LWCET) have poorer outcomes in general. Previous studies have found that American Indian (AI) children have higher rates of LWCET than other racial or ethnic groups. Therefore, this study aims to examine LWCET in AI children by exploring differences by ED location and utilization patterns. METHODS: This is a retrospective cohort study of five EDs in the upper Midwest between June 2011 and May 2012. We included all visits by children aged 0–17 who identified as African American (AA), AI or White. Logistic regression was used to determine differences in LWCET by race and ED location controlling for other possible confounding factors including sex, age, insurance type, triage level, distance from ED, timing of visit, and ED activity level. RESULTS: LWCET occurred in 1.73% of 68,461 visits made by 47,228 children. The multivariate model revealed that AIs were more likely to LWCET compared to White children (Odds Ratio (OR) = 1.62, 95% Confidence Interval (CI) = 1.30–2.03). There was no significant difference in LWCET between AA and White children. Other factors significantly associated with LWCET included triage level, distance from the ED, timing of visit, and ED activity level. CONCLUSION: Our results show that AI children have higher rates of LWCET compared to White children; this association is different from other racial minority groups. There are likely complex factors affecting LWCET in AI children throughout the upper Midwest, which necessitates further exploration. BioMed Central 2018-04-10 /pmc/articles/PMC5894126/ /pubmed/29636036 http://dx.doi.org/10.1186/s12913-018-3092-z Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Weber, Tess L.
Ziegler, Katherine M.
Kharbanda, Anupam B.
Payne, Nathaniel R.
Birger, Chad
Puumala, Susan E.
Leaving the emergency department without complete care: disparities in American Indian children
title Leaving the emergency department without complete care: disparities in American Indian children
title_full Leaving the emergency department without complete care: disparities in American Indian children
title_fullStr Leaving the emergency department without complete care: disparities in American Indian children
title_full_unstemmed Leaving the emergency department without complete care: disparities in American Indian children
title_short Leaving the emergency department without complete care: disparities in American Indian children
title_sort leaving the emergency department without complete care: disparities in american indian children
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894126/
https://www.ncbi.nlm.nih.gov/pubmed/29636036
http://dx.doi.org/10.1186/s12913-018-3092-z
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