Patterns and Variations in Emergency Department Visits for U.S. Children with Autism: A Rural-Urban Comparison

This proposed research addresses HRSA-MCH’s priority interest in health services utilization among children with autism and rural-urban differences. A recent study indicated that children with autism were more likely to visit an emergency department (ED) for psychiatric problems compared to children who don’t have autism. However, no research has explored how rural-urban differences are associated with ED visits for children with autism. This proposed study intends to fill this research gap through two specific aims: 1) examine rural-urban differences in the likelihood of ED visits, child characteristics associated with visits, and clinical measures of ED visits for U.S. children with autism, based on child’s residence location in rural or urban areas, and 2) describe differences between rural and urban hospitals regarding specific reasons for using the ED, volumes of ED visits, costs and clinical measures associated with these visits for U.S. children with autism; in addition, examine the determinants of hospital ED charges involving pediatric autism diagnosis in rural versus urban hospitals. We will use the 2010 and 2011 Nationwide Emergency Department Sample (NEDS), a database maintained by the Agency for Healthcare Research and Quality as a part of the Healthcare Cost and Utilization Project. We will investigate the rural-urban differences in ED visits for children with autism, by patient residence and by hospital location, respectively. Multilevel regression models will be used to correct for the non-independence of individual-level observations nested within hospital EDs and to determine whether disparities in ED utilization exist between children with autism in rural and urban settings. The proposed study will produce insights into the development of potential measures for comparison in future studies to assess the impact of health care coverage changes on health services utilization. The enactment of ACA and the implementation of the autism insurance mandate make this an opportune time for such research. This proposal represents one of the first studies to use the largest national dataset to study rural and urban differences in the utilization of autism-related ED services among children in the United States. Health interventions and health policies should carefully consider the nature of a distinct rural challenge with respect to access and utilization of health services for rural children with autism. The findings will contribute to a better informed policy and practice regarding health care utilization among children with autism in rural and urban areas.