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Study: Pediatric providers will be much busier under ACA

Sunday August 4, 2013
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Emergency and outpatient healthcare providers should prepare to treat up to 730,000 additional injuries a year to children and young adults when new healthcare coverage rules take effect in 2014, according to a study.

Those additional cases represent a 6.1% increase, researchers with The Childrenís Hospital of Philadelphia reported in a study published July 19 on the website of the journal Clinical Pediatrics.

According to the study, a significant portion of the increase will come from currently uninsured young adults (ages 18 to 26) who will be able to remain on their parents' insurance until age 26 or find affordable care through exchanges.

The researchers found that the causes and nature of medically attended injuries have differed between insured and uninsured young adults. The uninsured sought medical care for more serious injuries such as fractures, when compared with other types of injury. Those with insurance sought medical care for a wider distribution of injuries, most commonly sprains and strains as well as open wounds. Among insured children younger than 18, 11% of medically attended injuries were related to overexertion, but this injury mechanism did not cause uninsured children to seek care.

Flaura Koplin Winston, MD, PhD, of the Center for Injury Research and Prevention at CHOP, and her colleagues based their estimates on recent injury care data from the National Health Interview Survey and the assumption that the newly insured would have a probability of medically attended injury equal to those who already have insurance.

With these assumptions, they predicted that each year as many as 510,553 additional children and young adults could be seen for injury treatment in outpatient settings and nearly 195,838 in EDs or after admission to hospital, with another 30,689 being attended to through phone-only encounters. Winston cautioned that the actual health system utilization rates and sites of care may vary given that newly insured people may access care differently from those who already are insured.

"Healthcare delivery systems across the U.S. need to have sufficient numbers of general and pediatric healthcare providers who are trained in treating moderate trauma and injury and can staff urgent care centers, health centers, primary care practices, call centers and emergency departments," Winston said in a news release. "In keeping with the aims of the Affordable Care Act, the goal should be that all young patients who seek care for their injuries get the appropriate care at the right time and right place."

The authors recommended several steps healthcare systems can take to manage the potential increase in patients and avoid both the expensive overuse of emergency services and the long-term effects on communities of inadequately treated injury:

• Train clinicians with relevant course content on diagnosis and treatment of concussions, musculoskeletal injury, sports medicine and open wound care.

• Expand programs such as Poison Control Centers and call centers, and remote medical command for triage and treatment of non-life-threatening injuries.

• Prevent injuries to children by allocating federal and state resources to proven injury prevention strategies. These strategies cost less than medical care needed to treat injuries.

• Implement the CDCís National Action Plan for Childhood Injury Prevention (www.cdc.gov/safechild/NAP/).

• Develop or expand proven off-the-job injury prevention strategies. The cost of insuring this new population of youth, the majority of whom currently live with an employed head of household, may fall to employers.

Study abstract: http://cpj.sagepub.com/content/early/2013/07/17/0009922813495956.abstract.


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