TABLE 1.
Regional and ED Characteristics Associated With Whether an ED Had a Policy on How to Care for Children With Social or Mental Health Care Issues
| Characteristic | Policy for Children With Social and Mental Health Issues | PR (95% CI) |
|---|---|---|
| Overall | 1668/3612* (46.2%) | — |
| Urban/rural designations† | ||
| Urban | 1121/2032 (55.2%) | (Reference) |
| Suburban | 135/346 (39.0%) | 0.71 (0.62–0.81)‡ |
| Rural | 281/770 (36.5%) | 0.66 (0.60–0.73)‡ |
| Remote | 89/402 (22.1%) | 0.40 (0.33–0.48)‡ |
| Census division§ | ||
| Pacific | 72/147 (49.0%) | (Reference) |
| New England | 73/133 (54.9%) | 1.12 (0.89–1.40) |
| Middle Atlantic | 218/365 (59.7%) | 1.22 (1.01–1.47)‡ |
| East North Central | 288/637 (45.2%) | 0.92 (0.77–1.11) |
| West North Central | 166/538 (30.9%) | 0.63 (0.51–0.78)‡ |
| South Atlantic | 293/553 (53.0%) | 1.08 (0.90–1.30) |
| East South Central | 162/320 (50.6%) | 1.03 (0.85–1.26) |
| West South Central | 203/503 (40.4%) | 0.82 (0.68–1.00) |
| Mountain | 151/355 (42.5%) | 0.87 (0.71–1.07) |
| Islands | 42/61 (68.9%) | 1.41 (1.11–1.78)‡ |
| Hospital configurationǁ | ||
| Standby | 23/144 (16.0%) | (Reference) |
| Basic | 770/1899 (40.5%) | 2.54 (1.74–3.71)‡ |
| General | 597/1188(50.3%) | 3.15 (2.15–4.60)‡ |
| Comprehensive | 261/346 (75.4%) | 4.72 (3.23–6.90)‡ |
| Other | 17/35 (48.6%) | 3.04 (1.83–5.05)‡ |
| Pediatric patient volume¶ | ||
| Low | 467/1459 (32.0%) | (Reference) |
| Medium | 540/1114 (48.5%) | 1.51 (1.38–1.67)‡ |
| Medium high | 340/593 (57.3%) | 1.79 (1.62–1.98)‡ |
| High | 321/446 (72.0%) | 2.25 (2.05–2.47)‡ |
| No. children aged 0–17 y living at ≤FPL per county# | ||
| Quartile 1 (≤1200) | 229/889 (25.8%) | (Reference) |
| Quartile 2 (1201–3502) | 382/886 (43.1%) | 1.67 (1.46–1.92)‡ |
| Quartile 3 (3503–17,518) | 491/889 (55.2%) | 2.14 (1.89–2.43)‡ |
| Quartile 4 (17,519–299,330) | 524/886 (59.1%) | 2.30 (2.03–2.60)‡ |
| Percentage of children aged 0–17 y living at ≤FPL per county# | ||
| Quartile 1 (≤14.7%) | 408/891 (45.8%) | (Reference) |
| Quartile 2 (14.8%−20.6%) | 405/901 (45.0%) | 0.98 (0.89–1.09) |
| Quartile 3 (20.7%−25.5%) | 430/872 (49.3%) | 1.08 (0.98–1.19) |
| Quartile 4 (25.6%−66.3%) | 383/886 (43.2%) | 0.94 (0.85–1.05) |
Denominators for characteristics may not add to 3612 because of missing ED location data.
Urban/rural designations were classified as urban, suburban, rural, or remote using the US Department of Agriculture’s 2013 12-part county urban influence codes classification scheme.
Statistically significant difference from reference group where CI does not include 1.
Census divisions of the US categorized as New England (CT, MA, ME, NH, RI, VT), Middle Atlantic (NJ, NY, PA), East North Central (IL, IN, MI, OH, WI), West North Central (IA, KS, MN, MO, ND, NE, SD), South Atlantic (DC, DE, FL, GA, MD, NC, SC, VA, WV), East South Central (AL, KY, MS, TN), West South Central (AR, LA, OK, TX), Mountain (AZ, CO, ID, NM, MT, UT, NV, WY), Pacific (AK, CA, HI, OR, WA), and Islands (American Samoa, Federal States of Micronesia, Marshall Islands, Northern Mariana Islands, Palau, Puerto Rico, Virgin Islands), taken from https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf.
Hospital configuration was categorized as standby (a physician was on call to the ED), basic (a physician was present 24 hours but with no pediatric inpatient services), general (a physician was present 24 hours, and an inpatient pediatric ward, with or without a neonatal intensive care unit, was available), and comprehensive (a physician was present 24 hours, and an inpatient pediatric ward and a pediatric intensive care unit, with or without a neonatal intensive care unit, were available).
Pediatric patient volume was defined as low (<1800 patients in the past year, or an average of ≤5 a day), medium (1800–999 patients in the past year, or an average of 6–13 a day), medium high (5000–9999 patients in the past year, or an average of 14–26 a day), and high (≥10,000 patients in the past year, or an average of ≥27 a day).
Based on family income and family size and composition using federal poverty thresholds that are updated annually by the US Census Bureau using the change in the average annual consumer price index for all urban consumers.