Novel Use of Electronic Health Records to Quantify Patterns of Health Care Utilization for Pediatric Concussion
Methods: All patients, age 0-17 years, who had at least one clinical encounter with an ICD-9-CM diagnosis of concussion in The Children's Hospital of Philadelphia’s (CHOP) EHR system (7/1/2010−6/30/2014) were selected and their initial concussion-related encounter identified. Initial encounter location was described by relevant variables.
Results: 14,054 patients were included (average age: 12.1 years). Overall, 45% had their first encounter within primary care, 27%: specialty care, 6%: after-hours triage, and 19%: ED. For those with a CHOP primary care provider, 72% had their initial encounter within primary care and 11% within the ED. Healthcare entry varied by age with 0-4 year olds more often entering via the ED (37%) or after hours (26%) versus older children who entered via primary care (5-11: 69%; 12-14: 77%, 15-17: 78%).
Conclusions: This approach leveraged a unified EHR system across a large care network to describe the point of healthcare entry for children with a concussion across age and healthcare setting. Findings suggest that estimates of concussion incidence based solely on ED records likely underestimate the burden of injury and that point of entry varies by age.
Learning Areas:Clinical medicine applied in public health
Provision of health care to the public
Identify the strengths and limitations of using electronic health records as a source of data for concussion surveillance Describe the diversity of point of health care entry for children with concussion and how it varies by key factors
Qualified on the content I am responsible for because: I am a co-investigator on this study focusing on electronic health care records and concussion and am the PI of several studies that utilize CHOP's electronic health care records for research.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.