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Primary Care Quality and Subsequent Emergency Department Utilization for Children in Wisconsin Medicaid

  • David C. Brousseau
    Correspondence
    Address correspondence to David C. Brousseau, MD, MS, Department of Pediatrics, Medical College of Wisconsin, CCC 550, 999 N 92nd St, Milwaukee, Wisconsin 53226
    Affiliations
    Department of Pediatrics, Children's Research Institute, Medical College of Wisconsin (Dr Brousseau and Dr Gorelick); Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis (Dr Hoffmann); Division of General Pediatrics, Department of Pediatrics, UT Southern Medical Center, and Children's Medical Center, Dallas, Tex (Dr Flores); and Department of Medicine, Patient Care and Outcomes Research Center Medical College of Wisconsin, Milwaukee, Wis (Dr Nattinger)
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  • Marc H. Gorelick
    Affiliations
    Department of Pediatrics, Children's Research Institute, Medical College of Wisconsin (Dr Brousseau and Dr Gorelick); Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis (Dr Hoffmann); Division of General Pediatrics, Department of Pediatrics, UT Southern Medical Center, and Children's Medical Center, Dallas, Tex (Dr Flores); and Department of Medicine, Patient Care and Outcomes Research Center Medical College of Wisconsin, Milwaukee, Wis (Dr Nattinger)
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  • Raymond G. Hoffmann
    Affiliations
    Department of Pediatrics, Children's Research Institute, Medical College of Wisconsin (Dr Brousseau and Dr Gorelick); Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis (Dr Hoffmann); Division of General Pediatrics, Department of Pediatrics, UT Southern Medical Center, and Children's Medical Center, Dallas, Tex (Dr Flores); and Department of Medicine, Patient Care and Outcomes Research Center Medical College of Wisconsin, Milwaukee, Wis (Dr Nattinger)
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  • Glenn Flores
    Affiliations
    Department of Pediatrics, Children's Research Institute, Medical College of Wisconsin (Dr Brousseau and Dr Gorelick); Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis (Dr Hoffmann); Division of General Pediatrics, Department of Pediatrics, UT Southern Medical Center, and Children's Medical Center, Dallas, Tex (Dr Flores); and Department of Medicine, Patient Care and Outcomes Research Center Medical College of Wisconsin, Milwaukee, Wis (Dr Nattinger)
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  • Ann B. Nattinger
    Affiliations
    Department of Pediatrics, Children's Research Institute, Medical College of Wisconsin (Dr Brousseau and Dr Gorelick); Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis (Dr Hoffmann); Division of General Pediatrics, Department of Pediatrics, UT Southern Medical Center, and Children's Medical Center, Dallas, Tex (Dr Flores); and Department of Medicine, Patient Care and Outcomes Research Center Medical College of Wisconsin, Milwaukee, Wis (Dr Nattinger)
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      Objective

      Children enrolled in Medicaid have disproportionately high emergency department (ED) visit rates. Despite the growing importance of patient reported quality-of-care assessments, little is known about the association between parent-reported quality of primary care and ED utilization for these high-risk children. Our goal was to determine the association between parent-reported primary care quality and subsequent ED utilization for children in Medicaid.

      Methods

      We studied a retrospective cohort of children enrolled in Wisconsin Medicaid. Parents of children sampled during fall 2002 and fall 2004 completed Consumer Assessment of Healthcare Providers and Systems surveys assessing their child's primary care quality in 3 domains: family centeredness, timeliness, and realized access. Primary outcomes were the rates of subsequent nonurgent and urgent ED visits, extracted from claims data for the year after survey completion. Negative binomial regression was used to determine the association between the domains of care and ED utilization.

      Results

      A total of 5468 children were included. High-quality family centeredness was associated with a 27% (95% confidence interval [95% CI] 11%–40%) lower nonurgent ED visit rate, but no lowering of the urgent visit rate. High-quality timeliness was associated with 18% (95% CI, 3%–31%) lower nonurgent and 18% (95% CI, 1%–33%) lower urgent visit rates. High-quality realized access was associated with a 27% (95% CI, 8%–43%) lower nonurgent visit rate and a 33% (95% CI, 14%–48%) lower urgent visit rate.

      Conclusions

      Parent-reported high-quality timeliness, family centeredness, and realized access for a publicly insured child are associated with lower nonurgent ED, with high-quality timeliness and realized access associated with lower urgent ED utilization.

      Key Words

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