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Emergency Department Use and Perceived Delay in Accessing Illness Care Among Children With Medicaid

  • Alison A. Galbraith
    Correspondence
    Address correspondence to Dr Galbraith, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, 133 Brookline Ave, 6th Floor, Boston, MA 02215
    Affiliations
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  • Jeanne Semura
    Affiliations
    From the Robert Wood Johnson Clinical Scholars Program (Dr Galbraith), University of Washington, Seattle, Wash; Medical Assistance Administration (Dr Semura, Ms McAninch-Dake, Dr Anderson), Washington State Department of Social and Health Services, Olympia, Wash; and Department of Pediatrics and Child Health Institute (Dr Christakis), University of Washington and Children's Hospital and Regional Medical Center, Seattle, Washington
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  • Becky McAninch-Dake
    Affiliations
    From the Robert Wood Johnson Clinical Scholars Program (Dr Galbraith), University of Washington, Seattle, Wash; Medical Assistance Administration (Dr Semura, Ms McAninch-Dake, Dr Anderson), Washington State Department of Social and Health Services, Olympia, Wash; and Department of Pediatrics and Child Health Institute (Dr Christakis), University of Washington and Children's Hospital and Regional Medical Center, Seattle, Washington
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  • Nancy Anderson
    Affiliations
    From the Robert Wood Johnson Clinical Scholars Program (Dr Galbraith), University of Washington, Seattle, Wash; Medical Assistance Administration (Dr Semura, Ms McAninch-Dake, Dr Anderson), Washington State Department of Social and Health Services, Olympia, Wash; and Department of Pediatrics and Child Health Institute (Dr Christakis), University of Washington and Children's Hospital and Regional Medical Center, Seattle, Washington
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  • Dimitri A. Christakis
    Affiliations
    From the Robert Wood Johnson Clinical Scholars Program (Dr Galbraith), University of Washington, Seattle, Wash; Medical Assistance Administration (Dr Semura, Ms McAninch-Dake, Dr Anderson), Washington State Department of Social and Health Services, Olympia, Wash; and Department of Pediatrics and Child Health Institute (Dr Christakis), University of Washington and Children's Hospital and Regional Medical Center, Seattle, Washington
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      Background.—Children covered by Medicaid are at increased risk of emergency department (ED) utilization.
      Objective.—To examine whether an association exists between ED use and perceived delay in accessing acute care.
      Design and Setting.—Cross-sectional study. We used data from the Consumer Assessment of Health Plans Survey collected by Washington State Medicaid in 2000. We used multivariate logistic regression to determine the odds of any ED use, using a model that included whether the parent reported not always receiving illness care for the child as soon as wanted (perceived delay), age, gender, race/ethnicity, health status, presence of a special health care need, primary language, needing an interpreter, parental education, and having a regular provider.
      Subjects.—Parents of a random sample of children from 9 Medicaid managed care plans were surveyed if their children were <15 years old and enrolled at least 6 months.
      Main Outcome Measures.—Any ED use in the past 6 months.
      Results.—The response rate was 56.3%, yielding 5142 subjects. Of children with illnesses in the previous 6 months, 69.1% of parents reported that their child always received care as soon as they wanted; 19.9%, 8.2%, and 2.8% reported usually, sometimes, and never, respectively. Not always (vs always) receiving illness care as soon as wanted was significantly associated with increased odds of any ED use (adjusted odds ratio: 1.79; 95% confidence interval: 1.35– 2.36).
      Conclusion.—Children with managed care Medicaid are more likely to use the ED if parents perceive any delay in receiving illness care.

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