OBJECTIVES : The objective of this study was to assess the effectiveness of the Dayton Children’s Health Partners (DCHP) constipation co-management program. The primary outcome was the rate of constipation emergency department (ED) visits.

METHODS : De-identified patient data was obtained from a private insurer for pediatric ED visits for constipation between October 1, 2019 and September 30, 2020. Two cohorts were constructed: one in which the primary care provider (PCP) practices implemented the co-management program and one in which the practices had not. Multivariable logistic regression was performed to assess the difference between cohorts. Sensitivity analyses were performed to gauge the robustness of the results to alternative model specifications.

RESULTS : A total of 118 ED patient visits for constipation were identified from nine DCHP PCP practices. The program cohort had a constipation ED visit rate of 0.69 per 100 patients while the control cohort had a visit rate of 0.43 per 100 (p-value<0.001). Distance from the PCP practice to the nearest Dayton Children’s Hospital (DCH) ED was significant in increasing the odds of an ED visit (OR 1.17; p-value=0.001). The program cohort had a lower rate of low-acuity ED visits (27.3 per 100 constipation ED visits) compared to the control cohort (30.6 per 100; p-value=0.29). The odds of having a low-acuity ED visit significantly decreased as the patient got older (OR 0.87; p-value=0.004). The sensitivity analyses did not materially change the results.

CONCLUSIONS : The results show that the implementation of the constipation co-management program did not produce lower rates of ED visits for constipation over the examined time period. The distance of the PCP practice to the nearest DCH ED was the most significant factor. The rate of low-acuity ED visits for constipation, while lower for practices in the co-management program, failed to reach statistical significance.