Black children and children insured by Medicaid make more repeat emergency department visits for Crohn’s disease than their white and privately insured peers.
Columbus, OH — August 2018
In what appears to be the first nationally representative study evaluating the impact of race and insurance status on emergency department treatment for Crohn’s disease, a team of physicians and researchers at Nationwide Children’s Hospital has found that black children and those insured by Medicaid make more repeat visits and receive somewhat fewer treatments than their white and privately insured peers.
But in contrast to earlier literature demonstrating disparities in the kind of treatments received, adjusted analyses found no significant differences in the use of imaging, laboratory testing and medication among the populations. Small treatment differences were found when analyzing race and payor status separately, but controlling for one of those variables often mitigated the differences found with the other.
The study was published in Inflammatory Bowel Diseases. The lead author is Jennifer Dotson, MD, MPH, a gastroenterologist at Nationwide Children’s and principal investigator in the hospital’s Center for Innovation in Pediatric Practice.
“We did not always find that race or insurance explains differences in treatments for these patients with Crohn’s disease,” says Dr. Dotson. “We did find in some cases that there are fewer treatments for black children than white children, or for children with Medicaid than children with private insurance, but there are likely larger socioeconomic forces at work.”
Among the possible explanations: children with lower socioeconomic status may use emergency services for routine care more frequently, so they receive fewer services for each emergency department visit.
The study used data from the Pediatric Health Information System and ultimately considered 2,618 unique pediatric patients with a diagnosis of Crohn’s disease, with 3779 visits at 38 hospitals. A total of 77 percent of the patients were white and 23 percent were black. White children were more likely to have private insurance and have a higher median neighborhood income.
A higher proportion of black patients than white patients (33 percent vs. 22 percent) and a higher proportion of Medicaid-insured patients than privately insured patients (27 percent vs. 21 percent) had repeat ED visits. These findings highlight the need for strategies that address emergency department use for all patients, but especially for those who do not have optimal access to health care, the authors write.
The Nationwide Children’s Inflammatory Bowel Disease Center has all new patients go through a multidisciplinary IBD education course led by nurse educators, says Dr. Dotson, who is also an associate professor of Pediatrics at The Ohio State University Medical Center. Families familiar with the signs and symptoms of flare-up, armed with specific direction about who they should call with concerns, are more likely to use emergency services in the appropriate way.
“While resources are always going to be an issue, we need to use this opportunity for better outpatient management of children with IBD, assuring that everyone receives the appropriate care when they need it, and that non-emergent problems are more effectively handled in the office setting,” says Dr. Dotson.
Dotson JL, Kappelman MD, Bricker J, Andridge R, Chisolm DJ, Crandall WV. Multicenter evaluation of emergency department treatment for children and adolescents with Crohn's disease according to race/ethnicity and insurance payor status. Inflammatory Bowel Diseases. 2018 May 30. [Epub ahead of print]