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Analisi socio-economica degli accessi ripetuti al pronto soccorso pediatrico: il caso dell’Istituto G. Gaslini di Genova
Titolo Rivista: STUDI ECONOMICI  
Autori/Curatori: Enrico Di Bella, Lucia Fontana, Lucia Leporatti, Marcello Montefiori, Paolo Petralia 
Anno di pubblicazione:  2016 Fascicolo: 118-119-120  Lingua: Italiano 
Numero pagine:  16 P. 312-327 Dimensione file:  273 KB
DOI:  10.3280/STE2016-118017
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The use of Emergency Departments (EDs) is continuously increasing and the challenge of guaranteeing an efficient and effective service is threatened by the phenomena of inappropriate and frequent use. Most of the literature on the topic focuses on adult population; in this study we analyse the issue of frequent use of ED among paediatric patients, with the aim of detecting the most significant socio-demographic and clinical predictors of frequent use of emergency services. Results, based on data collected from the ED of one of the most important paediatric Italian Hospital, show that children aged less than 12 months, foreign and chronic patients (particularly those suffering from mental illness, respiratory diseases and circulatory system problems) have a higher risk of becoming frequent and highly frequent ED users. It emerges that frequent users, although they only represent the 8% of total number of accesses, they account for 19% of total costs.
Keywords: Paediatric emergency department, Frequent user, Healthcare system sustainability, Inappropriate use, Risk factors, chronic conditions
Jel Code: H51; I11, I12, C50

  1. Agenas – Agenzia Nazionale per i Servizi sanitari regionali. (2013), Assistenza H24 e riduzione degli accessi impropri in Pronto Soccorso: evidenze e indirizzi, I quaderni di Monitor, disponibile al sito:
  2. Akenroye A.T., Thurm C.W., Neuman M.I., Alpern E.R., Srivastava G., Spencer S.P., Simon H.K., Tejedor-Sojo J., Gosdin C.H., Brennan E., Gottlieb L.M., Gay J.C., McClead R.E., Shah S.S., Stack A.M. (2014), “Prevalence and predictors of return visits to pediatric emergency departments”, Journal of hospital medicine, 9(12), 779-787.
  3. Alessandrini E.A., Alpern E.R., Chamberlain J.M., Shea J.A., Gorelick M.H. (2010), “A new diagnosis grouping system for child emergency department visits”, Academic Emergency Medicine, 17(2), 204-213.
  4. Alpern E.R., Clark A.E., Alessandrini E.A., Gorelick M.H., Kittick M., Stanley R.M., Dean J.M., Teach S.J., Chamberlain J.M. (2014), “Recurrent and High‐frequency Use of the Emergency Department by Pediatric Patients”, Academic Emergency Medicine, 21(4), 365-373.
  5. Ameri M., Cremonesi P., Montefiori M. (2011), “The Effects of Inappropriate Emergency Department Use”, Studi Economici, 105(3), 123-136.
  6. Carret M.L.V., Fassa A.C.G., Domingues M.R. (2009), “Inappropriate use of emergency services: a systematic review of prevalence and associated factors”, Cadernos de Saúde Pública, 25(1), 7-28.
  7. Coffman J.M., Cabana M.D., Halpin H.A., Yelin E.H. (2008), “Effects of asthma education on children’s use of acute care services: a meta-analysis”, Pediatrics, 121(3), 575-586.
  8. Cook L.J., Knight S., Junkins E.P., Mann N.C., Dean J.M., Olson L.M. (2004), “Repeat patients to the emergency department in a statewide database”, Academic Emergency Medicine, 11(3), 256-263.
  9. Cremonesi P., Di Bella E., Montefiori M. (2010), “Cost analysis of emergency department”, Journal of preventive medicine and hygiene, 51(4), 157-163.
  10. Cremonesi P., di Bella E., Montefiori M., Persico L. (2015), “The robustness and effectiveness of the triage system at times of overcrowding and the extra costs due to inappropriate use of emergency departments”, Applied health economics and health policy, 13(5), 507-514.
  11. Davies F. (2009), “Emergency care for children: growing pains”, Emergency Medicine Journal, 26(3), 231-231.
  12. di Bella E., Gandullia L., Leporatti L., Montefiori M., Orcamo P. (2016), “Ranking and Prioritization of Emergency Departments Based on Multi-indicator Systems”, Social Indicators Research, 1-19.
  13. Ducharme F.M., Zemek R.L., Chalut D., McGillivray D., Noya F.J., Resendes S., Khomenko L., Rouleau R., Zhang X. (2011), “Written action plan in pediatric emergency room improves asthma prescribing, adherence, and control”, American journal of respiratory and critical care medicine, 183(2), 195-203.
  14. Durden T.E. (2007), “Usual source of health care among Hispanic children: the implications of immigration”, Medical Care, 45(8), 753-760.
  15. Franco S.M., Mitchell C.K., Buzon R.M. (1997), “Primary care physician access and gatekeeping: a key to reducing emergency department use”, Clinical pediatrics, 36(2), 63-68.
  16. Fuda K.K., Immekus R. (2006), “Frequent users of Massachusetts emergency departments: a statewide analysis”, Annals of Emergency Medicine, 48(1), 9-16.
  17. Green J., Dale J. (1990), “Health education and the inappropriate use of accident and emergency departments: the views of accident and emergency nurses”, Health Education Journal, 49(4), 157-161.
  18. Hilbe J.M. (2014), Modeling count data, New York, NY: Cambridge University Press.
  19. Kelly A.M., Chirnside A.M., Curry C.H. (1993), “An analysis of unscheduled return visits to an urban emergency department”, The New Zealand medical journal, 106(961), 334-336.
  20. LaCalle E., Rabin E. (2010), “Frequent users of emergency departments: the myths, the data, and the policy implications”, Annals of emergency medicine, 56(1), 42-48.
  21. LeDuc K., Rosebrook H., Rannie M., Gao D. (2006), “Pediatric emergency department recidivism: demographic characteristics and diagnostic predictors”, Journal of Emergency Nursing, 32(2), 131-138.
  22. Levaggi R., Montefiori M. (2013), “Definition of a prospective payment system to reimburse emergency departments”, BMC health services research, 13(1), p. 409.
  23. Leporatti L., Ameri M., Trinchero C., Orcamo P., Montefiori M. (2016), “Targeting frequent users of emergency departments: Prominent risk factors and policy implications”, Health Policy, 120(5), 462-470.
  24. Lewis L.M., Asplin B.R. (2010), “Pediatric emergency departments are not ‘little’ adult emergency departments”, Academic Emergency Medicine, 17(2), 202-203.
  25. Mandelberg J.H., Kuhn R.E., Kohn M.A. (2000), “Epidemiologic analysis of an urban, public emergency department’s frequent users”, Academic emergency medicine, 7(6), 637-646.
  26. Milbrett P., Halm M. (2009), “Characteristics and predictors of frequent utilization of emergency services”, Journal of Emergency Nursing, 35(3), 191-198.
  27. Miro O., Antonio M.T., Jimenez S., De Dios A., Sanchez M., Borras A., Milla J. (1999), “Decreased health care quality associated with emergency department overcrowding”, European Journal of Emergency Medicine, 6(2), 105-107.
  28. Neuman M.I., Alpern E.R., Hall M., Kharbanda A.B., Shah S.S., Freedman S.B., Aronson P.L., Florin T.A., Mistry R.D., Berry J.G. (2014), “Characteristics of recurrent utilization in pediatric emergency departments”, Pediatrics, 134, 4, e1025-1031.
  29. Prince M., Worth C. (1992), “A study of ‘inappropriate’ attendances to a pediatric accident and emergency department”, Journal of Public Health, 14(2), 177-182.
  30. Uscher-Pines L., Pines J., Kellermann A., Gillen E., Mehrotra A. (2013), “Deciding to visit the emergency department for non-urgent conditions: a systematic review of the literature”, The American Journal of Managed Care, 19(1), 47-59.
  31. Wassmer R.W., Winward L., Derlet R. (2008), “Does counseling reduce frequent emergency department use?”. --Disponibile al sito: 1093870 or
  32. Wier L.M., Yu H., Owens P.L., Washington R. (2006), “Overview of children in the emergency department, 2010”, Statistical Brief# 157.
  33. World Health Organization (2013), Global action plan for the prevention and control of noncommunicable diseases 2013-2020, -- disponibile al sito:
  34. Zuckerman S., Shen Y.C. (2004), “Characteristics of occasional and frequent emergency department users: do insurance coverage and access to care matter?”, Medical care, 42(2), 176-182.

Enrico Di Bella, Lucia Fontana, Lucia Leporatti, Marcello Montefiori, Paolo Petralia, in "STUDI ECONOMICI " 118-119-120/2016, pp. 312-327, DOI:10.3280/STE2016-118017


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