1. Value-based comparison of ambulatory children with respiratory diseases in an emergency department and a walk-in clinic: a retrospective cohort study in Québec, Canada.
- Author
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Marx T, Moore L, Talbot D, Guertin JR, Lachapelle P, Blais S, Singbo N, Simonyan D, Lavallée J, Zada N, Shahrigharahkoshan S, Huard B, Olivier P, Mallet M, Létourneau M, Lafrenière M, Archambault P, and Berthelot S
- Subjects
- Humans, Child, Retrospective Studies, Female, Male, Child, Preschool, Quebec, Adolescent, Asthma drug therapy, Asthma economics, Ambulatory Care statistics & numerical data, Ambulatory Care economics, Anti-Bacterial Agents therapeutic use, Anti-Bacterial Agents economics, Health Care Costs statistics & numerical data, Pneumonia epidemiology, Pneumonia economics, Pneumonia drug therapy, Emergency Service, Hospital statistics & numerical data, Respiratory Tract Infections economics, Respiratory Tract Infections epidemiology, Respiratory Tract Infections drug therapy, Ambulatory Care Facilities statistics & numerical data, Ambulatory Care Facilities economics
- Abstract
Objective: To compare health outcomes and costs given in the emergency department (ED) and walk-in clinics for ambulatory children presenting with acute respiratory diseases., Design: A retrospective cohort study., Setting: This study was conducted from April 2016 to March 2017 in one ED and one walk-in clinic. The ED is a paediatric tertiary care centre, and the clinic has access to lab tests and X-rays., Participants: Inclusion criteria were children: (1) aged from 2 to 17 years old and (2) discharged home with a diagnosis of upper respiratory tract infection (URTI), pneumonia or acute asthma., Main Outcome Measures: The primary outcome measure was the proportion of patients returning to any ED or clinic within 3 and 7 days of the index visit. The secondary outcome measures were the mean cost of care estimated using time-driven activity-based costing and the incidence of antibiotic prescription for URTI patients., Results: We included 532 children seen in the ED and 201 seen in the walk-in clinic. The incidence of return visits at 3 and 7 days was 20.7% and 27.3% in the ED vs 6.5% and 11.4% in the clinic (adjusted relative risk at 3 days (aRR) (95% CI) 3.17 (1.77 to 5.66) and aRR at 7 days 2.24 (1.46 to 3.44)). The mean cost (95% CI) of care (CAD) at the index visit was $C96.68 (92.62 to 100.74) in the ED vs $C48.82 (45.47 to 52.16) in the clinic (mean difference (95% CI): 46.15 (41.29 to 51.02)). Antibiotic prescription for URTI was less common in the ED than in the clinic (1.5% vs 16.4%; aRR 0.10 (95% CI 0.03 to 0.32))., Conclusions: The incidence of return visits and cost of care were significantly higher in the ED, while antibiotic use for URTI was more frequent in the walk-in clinic. These data may help determine which setting offers the highest value to ambulatory children with acute respiratory conditions., Competing Interests: Competing interests: SBerthelot, LM, DT, PA and JRG currently hold FRQS research scholarships., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2024
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