Research Data from Dartmouth College Update Understanding of Managed Care (Rural-urban Differences In Emergency Department Choice for Children With Medical Complexity, 2012-2017): Managed Care

2025 DEC 24 (NewsRx) -- By a News Reporter-Staff News Editor at Hospital & Nursing Home Daily -- New research on Managed Care is the subject of a report. According to news reporting from Hanover, New Hampshire, by NewsRx journalists, research stated, “Children with medical complexity (CMC) may bypass emergency departments (EDs) close to home to seek care at hospitals with more specialized pediatric services. However, few studies have examined ED choice for CMC or how this differs by rurality.”

Financial support for this research came from National Institute on Minority Health and Health Disparities of the National Institutes of Health.

The news correspondents obtained a quote from the research from Dartmouth College, “This work describes rural-urban differences in ED care and bypass patterns, examines associations between ED bypass and visit outcomes, and identifies factors associated with ED bypass. We analyzed 2012 to 2017 all-payer claims data from Colorado, Massachusetts, and New Hampshire. Bypass was defined as a driving time of >= 5 minutes than time to the closest ED. We used logistic regression to identify factors associated with ED bypass and examine associations between bypass and rates of inter-facility transfer, index hospital admission, and in-hospital mortality. In total, 82,747 CMC experienced 284,374 ED visits. Rural-residing CMC were more often insured by Medicaid, more likely to travel >30 minutes, and less likely to bypass their closest EDs (26.9% vs. 43.7% for urban-residing CMC). In adjusted regression models, ED bypass was associated with significantly increased odds of admission (OR=2.19, 95% CI: 1.51-3.16) but not with interfacility transfer or mortality. Chronic condition primary diagnosis was associated with increased odds of bypass, and Medicaid coverage was associated with decreased odds of bypass for both rural-residing and urban-residing CMC. Rural-residing and urban-residing CMC differed in where they sought ED care and in their ED bypass patterns.”

According to the news reporters, the research concluded: “These findings illustrate several factors that may be associated with ED choice for CMC and can inform clinical improvement efforts for this population.”

This research has been peer-reviewed.

For more information on this research see: Rural-urban Differences In Emergency Department Choice for Children With Medical Complexity, 2012-2017. Pediatric Emergency Care, 2025;41(12):957-964. Pediatric Emergency Care can be contacted at: Lippincott Williams & Wilkins, Two Commerce Sq, 2001 Market St, Philadelphia, PA 19103, USA. (Lippincott Williams and Wilkins - www.lww.com; Pediatric Emergency Care - http://journals.lww.com/pec-online/pages/default.aspx)

Our news journalists report that additional information may be obtained by contacting Seneca D. Freyleue, Dartmouth College, Geisel School of Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, United States. Additional authors for this research include Andrew P. Schaefer, Erika L. Moen, A. James O’malley, David C. Goodman, Joanna K. Leyenaar and Mary Arakelyan.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1097/PEC.0000000000003469. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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