Hospital emergency department visits made by developmentally disabled adolescents with oral complications

Kathryn A Atchison; Vinodh Bhoopathi; Christine R Wells

doi:10.3389/froh.2022.955584

Hospital emergency department visits made by developmentally disabled adolescents with oral complications

Front Oral Health. 2022 Aug 15:3:955584. doi: 10.3389/froh.2022.955584. eCollection 2022.

Authors

Kathryn A Atchison¹, Vinodh Bhoopathi¹, Christine R Wells²

Affiliations

¹ Section of Public & Population Health, School of Dentistry, University of California, Los Angeles, Los Angeles, CA, United States.
² Statistical Methods and Data Analytics, Office of Advanced Research Computing, University of California, Los Angeles, Los Angeles, CA, United States.

Abstract

Purpose: We used Andersen's Behavioral Model in a cross-sectional study to determine the factors associated with utilization of the emergency department (ED), controlling for whether an adolescent has a developmental disability (DD) and one or more oral complications (toothaches, decayed teeth, bleeding gums, eating or swallowing problems).

Methods: Data from the 2016-2019 National Survey of Children's Health (NSCH) was used for this secondary data analysis study. We used frequencies and percentages to describe the sample characteristics. Chi-square tests were used for bivariate analyses. Multivariable logistic regression modeling was conducted to predict ED visits by adolescents aged 10-17 controlling for predisposing, enabling, and need variables.

Results: The sample consisted of 68,942 adolescents who were primarily male, non-Hispanic White, and born in the U.S. Parents reported that 69% of the adolescents had neither a DD nor an oral complication; 10% had no DD but experienced one or more oral complication; 16% had a DD but no oral complication; and 5% had both DDs and one or more oral complication. Adolescents with both a DD and an oral complication reported the highest level of ED visits at 33%, compared to 14% of adolescents with neither DD nor oral complication. Regression analysis showed that adolescents with a DD and oral complication (OR: 2.0, 95% CI: 1.64-2.54, p < 0.0001), and those with DDs but no oral complications (OR: 1.45, 95% CI: 1.25-1.68, p < 0.0001) were at higher odds of having an ED visit compared to those with neither a DD nor an oral complication. Not having a Medical Home increased the likelihood of ED visits by 14% (p = 0.02). Those with private insurance (OR: 0.63, 95% CI: 0.53-0.75, p < 0.0001) and those from a family where the highest level of education was some college and above (OR: 0.85, 95% CI: 0.73-0.98, p = 0.03) were less likely than their counterparts to have had an ED visit.

Conclusion: Adolescents with DDs and oral complications utilize ED visits more frequently than those with neither DDs nor oral complications. Integrating the dental and medical health systems and incorporating concepts of a Patient-Centered Medical Home could improve overall health care and reduce ED visits for adolescents.

Keywords: Andersen's Behavioral Model of Health Services use; Medical Home; National Survey of Children's Health (NSCH); adolescent oral health; children with special health care needs (CSHCN); dental caries; developmentally disabled children; emergency department use.