Assessing the Relationship Between Well-Care Visit and Emergency Department Utilization Among Adolescents and Young Adults


To investigate the association between adolescent and young adult (AYA) well-care visits and emergency department (ED) utilization. 


Vermont's all-payer claims data were used to evaluate visits for 49,089 AYAs (aged 12-21 years) with a health-care claim from January 1 through December 31, 2018. We performed multiple logistic regression analyses to determine the association between well-care visits and ED utilization, investigating potential moderating effects of age, insurance type, and medical complexity.


Nearly half (49%) of AYAs who engaged with the health-care system did not attend a well-care visit in 2018. AYAs who did not attend a well-care visit had 24% greater odds (95% confidence interval [CI]: 1.19–1.30) of going to the ED at least once in 2018, controlling for age, sex, insurance type, and medical complexity. Older age, female sex, Medicaid insurance, and greater medical complexity independently predicted greater ED utilization in the adjusted model. In stratified analyses, late adolescents and young adults (aged 18-21 years) who did not attend a well-care visit had 47% greater odds (95% CI: 1.37 - 1.58) of ED visits, middle adolescents (aged 15-17 years) had 9% greater odds (95% CI: 1.01–1.18), and early adolescents (aged 12-14 years) had 16% greater odds (95% CI: 1.06 - 1.26).


Not attending well-care visits is associated with greater ED utilization among AYAs engaged in health care. Focus on key quality performance metrics such as well-care visit attendance, especially for 18- to 21-year-olds during their transition to adult health care, may help reduce ED utilization.


Assessing the Relationship Between Well-Care Visit and Emergency Department Utilization Among Adolescents and Young Adults

Jennifer E.Holland, Susan E.Varni, Christian D.Pulcini, Tamara D.Simon, Valerie S.Harder                                           

Journal of Adolescent Health Jan 2022, 70 (1) 64-69; DOI: 10.1016/j.jadohealth.2021.08.011

Corresponding Author:

Valerie Harder

Healthcare Utilization and Transitions for Adolescents with Special Health Care Needs


Nearly twenty percent of adolescents have health consequences attributable to persistent medical, behavioral, or other health conditions, and the number of adolescents with special health care needsSpecial HC needs child, mom, dr(ASHCN) that survive into adulthood continues to increase.

There is evidence that the patient-centered medical home (PCMH) health care delivery model provides children more effective, efficient, and timely care at lower cost, particularly among the highest utilizers: children with special health care needs.

The hypotheses are that ASHCN in PCMHs will have more primary care visits, fewer emergency room visits, fewer inpatient stays, and fewer hospital readmissions within 30 days and will be more likely to successfully transition to adult providers than ASHCN not in PCMHs.

The two studies proposed to test these hypotheses are designed to (1) measure the impact of PCMH recognition on health care service utilization among ASHCN by level of medical complexity and (2) assess the successful transition of ASHCN from a pediatric PCMH to an adult provider by ASHCN level of medical complexity.