Receipt of needed care coordination and emergency department utilization among US children with chronic physical pain: a pooled analysis of the 2022-2024 National Survey of Children's Health.

BACKGROUND

Children with chronic physical pain often require complex, multidisciplinary services across medical, behavioral, and community systems. However, whether receipt of needed care coordination is associated with acute healthcare utilization and care access in this population remains poorly characterized.

METHODS

We conducted a pooled cross-sectional analysis of the 2022-2024 National Survey of Children's Health (NSCH). The analytic cohort included US children aged 6-17 years with caregiver-reported chronic physical pain who had an identified need for care coordination. The exposure was receipt of needed care coordination. The primary outcome was all-cause emergency department (ED) utilization (≥1 visit) in the prior 12 months. Survey-weighted multivariable logistic regression was used, with a minimally adjusted model (sociodemographic factors) and a fully adjusted model (additionally including insurance status, anxiety, depression, and functional difficulties) reported side by side.

RESULTS

Among 6,326 eligible children (representing an average of 878,491 children annually), weighted 12-month ED visit rates were 29.0% (95% CI, 25.4%-32.5%) for those who received needed care coordination versus 40.0% (95% CI, 36.4%-43.7%) for those who did not. In the minimally adjusted model, receipt of needed care coordination was associated with lower odds of ED utilization (adjusted OR [aOR] 0.61; 95% CI, 0.48-0.76; P < .001; n = 6,310). This association persisted in the fully adjusted model (aOR 0.69; 95% CI, 0.54-0.87; P = .0019; n = 6,145) and was consistent for recurrent ED visits (≥2 visits: aOR 0.54; 95% CI, 0.36-0.79; P = .0015). Receipt of care coordination was also associated with substantially lower odds of unmet healthcare needs (aOR 0.32; 95% CI, 0.23-0.45) and forgone mental health care (aOR 0.21; 95% CI, 0.13-0.33). The estimate for hospital stay was imprecise and included the null (aOR 0.61; 95% CI, 0.37-1.01; P = .053).

CONCLUSION

Among US children with chronic physical pain who needed care coordination, receipt of needed care coordination was associated with lower odds of all-cause ED use and reported healthcare access gaps. These cross-sectional findings do not establish temporal ordering or causal effects and should be evaluated in prospective studies.