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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Article Info
Publication History
Accepted:
November 11,
2008
Received:
August 8,
2008
Identification
Copyright
© 2009 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
