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Ambulatory Care: Emergency Department (ED) Visits: Ages 0 to 19


VISIT THE DOMAIN: Make Care Affordable

Unnecessary visits to a hospital emergency department (ED) may indicate lack of access to more appropriate sources of medical care, such as primary care providers or specialists. Excessive visits to the ED can result in overcrowding and increased ED wait times. Understanding the rate of ED visits among children covered by Medicaid and Children’s Health Insurance Program (CHIP) can help states identify strategies to improve access to and utilization of appropriate sources of care.

Explore the rate of ED visits per 1,000 beneficiary months for children and adolescents in each state. Lower rates are better on this measure.

The purple dashed line represents the median, or middle, of all values reported.

This measure reports state performance on the rate of ED visits per 1,000 beneficiary months for children up to age 19.

States voluntarily report on Ambulatory Care: Emergency Department Visits (AMB-CH) as part of the Core Set of Children's Health Care Quality Measures. These data show performance rates for states that voluntarily reported the measure using Child Core Set measure specifications.

The included populations for Child Core Set measures can vary by state. For example, some states report a single combined rate for both the Medicaid and CHIP populations, but other states report separate rates for these populations. In addition, states may include beneficiaries in some delivery systems, but exclude other delivery systems. For example, a state may include beneficiaries who are enrolled in managed care, but exclude beneficiaries who are covered on a fee-for-service (FFS) basis. This variation in populations can affect measure performance and comparisons between states.

Source: Mathematica analysis of Medicaid and CHIP Program System (MACPro) reports for the Child Core Set Federal Fiscal Year (FFY) 2019 reporting cycle as of May 31, 2020; see 2019 Child and Adult Health Care Quality Measures. For more information on the Ambulatory Care: Emergency Department Visits (AMB-CH) measure, visit Child Health Care Quality Measures.

Notes:

The following states did not report data to the Centers for Medicare & Medicaid Services (CMS) for this measure: ID, MT, ND and SD.

The Child Core Set specifications include guidance for calculating this measure using the administrative method.  Unless otherwise specified, the administrative data source is the state’s Medicaid Management Information System (MMIS) and/or data submitted by managed care plans, including behavioral health plans.

Unless otherwise specified:

  • States used Child Core Set specifications, based on National Committee for Quality Assurance (NCQA) 2019 specifications. The following state used NCQA 2018 specifications: OR.
  • Denominators are assumed to be the measure-eligible population for states using the administrative method. Some states reported exclusions from the denominator, as noted in the state-specific comments.
  • The measurement period for this measure was January 1, 2018 to December 31, 2018. AZ reported data for FFY 2018.

ACO = Accountable Care Organization; ADHD = Attention-Deficit/Hyperactivity Disorder; CCO = Coordinated Care Organization; CHIP = Children’s Health Insurance Program; CMS = Centers for Medicare & Medicaid Services; CPT = Current Procedural Terminology; CY = Calendar Year; ED = Emergency Department; EPSDT = Early and Periodic Screening, Diagnostic, and Treatment; EQRO = External Quality Review Organization; FFS = Fee for Service; FFY = Federal Fiscal Year; HEDIS = Healthcare Effectiveness Data and Information Set; HMO = Health Maintenance Organization; ICD = International Classification of Diseases; LOINC = Logical Observation Identifiers Names and Codes; MACPro = Medicaid and CHIP Program System; MCO = Managed Care Organization; MMIS = Medicaid Management Information System; NCQA = National Committee for Quality Assurance; NR = Not Reported; PCCM = Primary Care Case Management; PCP = Primary Care Practitioner.