Author(s)
I. M. Tam
S. D. Candrilli
J. R. Moss
Affiliation(s)
Otonomy, Inc.; RTI Health Solutions; Charlotte Eye, Ear, Nose, And Throat Associates
Abstract:
INTRODUCTION: Tympanostomy tube (TT) placement is the most common ambulatory surgery performed on children in the US. Tube otorrhea is a common post-surgical sequelae requiring physician follow-up. However, it is known that some patients seek care in the emergency department (ED) rather than the physician office, significantly increasing the cost of care. OBJECTIVE: To evaluate rates of post-TT ED visits, both all-cause and otorrhea-related, among Medicaid-enrolled and commercially insured pediatric populations. METHODS: Medical and pharmacy insurance claims data from the Truven MarketScan 11-State Medicaid and Commercial Claims and Encounters databases were used. Patients =17 years old undergoing TT placement between 1/1/09 and 12/31/13 were selected for inclusion. The main endpoint was ED encounters within 30 days post-TT placement, both all-cause and with a primary diagnosis code for otorrhea. RESULTS: 128,472 Medicaid-enrolled and 240,375 commercially insured patients met all study inclusion criteria. Within 30 days following tube placement, the rate of all-cause ED visits was twice as high in the Medicaid-enrolled when compared to the commercially insured population (8.0% vs. 3.9%, p<0.0001). Otorrhea-related ED visits were nearly four-fold higher (p<0.0001) in Medicaid-enrollees. CONCLUSIONS: The rate of ED visits within 30 days following tube placement was significantly greater among Medicaid-enrolled pediatric patients than those with commercial insurance, both all-cause and otorrhea-related. Providers should consider these findings when considering treatment choices for Medicaid enrollees and educating patients/caregivers on appropriate follow-up care which may help decrease the utilization of ED for non-emergency encounters.