Faculty Collaboration Database

Quality of primary care and subsequent pediatric emergency department utilization. Pediatrics 2007 Jun;119(6):1131-8

Date

06/05/2007

Pubmed ID

17545380

DOI

10.1542/peds.2006-3518

Scopus ID

2-s2.0-34249867646 (requires institutional sign-in at Scopus site)   118 Citations

Abstract

OBJECTIVE: Our objective was to determine whether parent-reported, high-quality primary care was associated with decreased nonurgent pediatric emergency department utilization.

METHODS: A retrospective analysis of prospectively collected data for a cohort of children from the 2000-2001 and 2001-2002 Medical Expenditure Panel Survey panels was performed. Baseline parent-reported quality of primary care with respect to family-centeredness, timeliness, and realized access (a measure of the child's ability to receive necessary care and referrals) was assessed by using composite scores from the Consumer Assessment of Healthcare Providers and Systems survey. The primary outcomes were the numbers of subsequent nonurgent and urgent emergency department visits per child.

RESULTS: Of 8823 children included, 70.0% rated family-centeredness, 88.2% rated realized access, and 55.6% rated timeliness as high quality. After adjustment for demographic factors and health status, high-quality family-centeredness was associated with a 42% reduction in nonurgent emergency department visits for publicly insured children and a 49% reduction for children < or = 2 years of age. Greater realized access was associated with a 44% reduction in nonurgent emergency department visits for children 3 to 11 years of age and a 56% reduction for children > or = 12 years of age. Greater realized access was also associated with decreased nonurgent emergency department visits for publicly and privately insured children (37% and 35%, respectively). There was no significant association between timeliness and nonurgent emergency department utilization, nor was any quality-of-care domain associated with urgent emergency department utilization.

CONCLUSIONS: Parent-reported, high-quality family-centeredness and a high level of realized access to primary care were associated with decreased subsequent nonurgent emergency department visits for children. Parent reports of health care quality in these domains provide important complementary information on health care quality.

Author List

Brousseau DC, Hoffmann RG, Nattinger AB, Flores G, Zhang Y, Gorelick M

Author

Ann B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Cohort Studies
Emergency Service, Hospital
Female
Humans
Infant
Infant, Newborn
Male
Primary Health Care
Prospective Studies
Quality of Health Care
Retrospective Studies