Health Care, Access, Insurance
Children's Repeat Dental ED Visits in Florida, Maryland and Massachusetts
(DentaQuest Institute Other )
Objectives To evaluate factors associated with repeat visits to the Emergency Department (ED) for dental/oral health-related conditions (DOHRC) for pediatric patients’ ages 0-5 in three states. Approach Patients receiving care in the ED for DOHRC were identified using ICD-9-CM diagnosis codes of 520.00-529.9. DOHRC are also classified by preventability and severity. State Emergency Departments Databases (SEDD) from Florida, Maryland, and Massachusetts for 2013 served as the source of data. Independent variables include race, gender, location, income, payer, and comorbidities. Findings In all three states, the majority of children ages 0-5 who visited the ED for a DOHRC in 2013 did so two or more times. Rates of repeat visits are particularly high in Florida, where 25% of all DOHRC patients have 5 or more visits to the ED Massachusetts has few ED visits for DOHRC among children in this age group, but the majority of patient’s visited more than once. Children who have repeat visits to the ED for DOHRC tend to have low severity conditions that may have been prevented through routine dental care. Children with DOHRC discharges have fewer comorbidities than children who visit the ED for a medical reason. In all three states, non-white boys who live in low income areas are the most likely to have repeat visits to the ED for DOHRC. Racial disparities are particularly prominent in Florida and Maryland. Medicaid pays over 80% of all repeat visits to the DOHRC in these states. Conclusions Treatment for DOHRC in the ED is non-definitive and palliative, causing many children to return to the ED for treatment of the same or similar condition. These findings highlight the need for better education and preventative care inside dental and primary care settings to reduce costly and unnecessary ED visits for DOHRC. Public Health Significance DOHRC ED visits create a burden on the ED and Medicaid systems. These results suggest that these visits are preventable. Public health strategies to reduce DOHRC visits include increased access to primary dental care, improved education and preventative care in dental and primary care settings, and improved care coordination between dental and medical services.