PURPOSE Identifying factors associated with emergency visits that could be delivered at lower-cost sites may help guide population health strategies for pediatric patients with spina bifida. MATERIALS AND METHODS Emergency department encounters (2016-2023) by patients with spina bifida (< 18-years-old) in Pediatric Health Information System were identified. Absence of clinical and imaging charges was defined as low-value emergency visit. We utilized a control population of patients (<18-years-old) with obstructive/reflux uropathy who presented for emergency department encounters (2016-2023). Mixed effects (with repeated individual measurements as random effect) logistic regression was fitted to model odds of low-value emergency visit. RESULTS In total, we included 22,672 emergency visits by patients with spina bifida. 20.7% of these emergency visits were low-value versus 17.7% in controls (p<0.001). Costs related to low-value emergency visits account for 3.8% of all costs for emergency visit-related encounters in patients with spina bifida. Low-value emergency visits were associated with younger age [OR 1.05 (1.04 - 1.06) per year younger], Hispanic/Latino [OR 1.21 (1.06 - 1.39) compared to non-Hispanics], black [OR 1.35 (1.16 - 1.58) compared to white], public insurance [OR 1.14 (1.01 - 1.29) compared to private insurance], and genitourinary encounter diagnosis [OR 1.16 (1.04 - 1.30)]. Using a standard patient, we found that the odds of low-value emergency visit across hospitals ranged from 0.31 to 5.36. CONCLUSIONS Younger age, Hispanic/Latino ethnicity, black and other race, public insurance, and genitourinary encounter diagnosis were associated with higher odds for low-value emergency visits in pediatric patients with spina bifida. There was wide variation across hospitals that warrants further investigation to elucidate best practices.

中文翻译：

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与脊柱裂儿科患者低价值急诊科就诊相关的临床和人口统计学因素。


目的 确定可以在低成本地点提供的紧急就诊相关因素可能有助于指导脊柱裂儿科患者的人口健康策略。材料和方法 在儿科健康信息系统中确定了脊柱裂患者 （< 18 岁） 的急诊科就诊情况 （2016-2023）。没有临床和影像学费用被定义为低价值急诊就诊。我们利用了因急诊科就诊 （2016-2023） 的梗阻/反流性尿路病患者对照人群 （<18 岁）。混合效应 （重复个体测量作为随机效应） logistic 回归用于低值急诊就诊的模型几率。结果 我们总共纳入了 22,672 例脊柱裂患者的急诊就诊。这些急诊就诊中有 20.7% 是低值，而对照组为 17.7% （p<0.001）。与低价值急诊就诊相关的费用占脊柱裂患者急诊就诊相关就诊所有费用的 3.8%。低价值急诊就诊与年龄较小 [OR 1.05 （1.04 - 1.06） 相比）、西班牙裔/拉丁裔 [OR 1.21 （1.06 - 1.39） 与非西班牙裔相比）、黑人 [OR 1.35 （1.16 - 1.58） 与白人相比）、公共保险 [OR 1.14 （1.01 - 1.29） 与私人保险相比]和泌尿生殖系统遭遇诊断 [OR 1.16 （1.04 - 1.30）]。使用标准患者，我们发现医院低价值急诊就诊的几率在 0.31 到 5.36 之间。结论 年龄较小、西班牙裔/拉丁裔、黑人和其他种族、公共保险和泌尿生殖系统就诊诊断与脊柱裂儿科患者低价值急诊就诊的几率较高相关。 各家医院之间存在很大差异，需要进一步调查以阐明最佳实践。