University of Wisconsin–Madison Medical College of Wisconsin

Changes in Health Care Utilization for Pediatric Patients Treated at a Specialized Outpatient Pain Clinic

Antionette Spector, DPT, OCS; Ruta Brazauskas, PhD; Keri Hainsworth, PhD; George M. Hoffman, MD; Steven Weisman, MD; Laura D. Cassidy, MS, PhD

WMJ. 2019;118(4):164-168.

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Introduction: Pediatric pain clinics may be the most efficacious way to manage chronic and recurrent pain in children and adolescents, but families often rely heavily on nonspecialized care, such as the emergency department (ED). Health care utilization patterns for pediatric chronic pain have not been fully explored, particularly the patient-level factors that may contribute to underutilization or overutilization of certain services.

Objectives: To identify health care utilization patterns before and after treatment at a pediatric pain clinic and the associations by primary diagnosis and patient sociodemographics.

Methods: Data were obtained for all pediatric patients with an initial visit at an outpatient pediatric pain clinic between 2005 and 2009. Individual-level data included patient demographics, insurance type, and diagnosis at first pain clinic visit. Rate of health care system utilization 3 months before and after the initial pain clinic visit was quantified. Health care utilization rates before and after the initial visit to the pain clinic were compared using Wilcoxon signed-rank test.

Results: Eight hundred twenty-six pediatric pain clinic patients were included. Overall, there were significant decreases in ED utilization (P < 0.001) and increases in outpatient service utilization (P < 0.001) after the initial pain clinic visit. Similar patterns were noted for patients by diagnosis (headache, musculoskeletal, or abdominal pain diagnoses) and among those who were female, white, 15 to 18 years old, privately insured, middle- or high-income (P < 0.05).

Conclusions: Visits to an outpatient pediatric pain clinic were associated with shifts in health care utilization patterns. Important changes were an overall decrease in emergency visits and an increase in outpatient visits.


Author Affiliations: Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wis (Spector, Brazauskas, Cassidy); Children’s Hospital of Wisconsin, Milwaukee, Wis (Hainsworth, Hoffmann, Weisman).
Corresponding Author: Antoinette Spector, DPT, OCS, Institute for Health and Equity, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee WI, 53226; 414.955.7386; email
Funding/Support: None declared.
Financial Disclosures: None declared.
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