Relationship between early primary care and emergency department use in early infancy by the medicaid population

Area of Science:

• Pediatrics
• Health Services Research
• Public Health

Background:

• Access to primary care is crucial for infant health.
• Understanding factors influencing emergency department (ED) utilization in early infancy is important for resource allocation and care coordination.
• Medicaid recipients represent a vulnerable population for whom primary care access and subsequent healthcare utilization patterns require investigation.

Purpose of the Study:

• To investigate the association between the timing and type of primary care engagement and emergency department (ED) visits in the first 91 days of life among healthy, Medicaid-enrolled infants.
• To determine if early linkage to primary care influences the rate of ED utilization in early infancy.

Main Methods:

• A population-based cohort study utilizing linked birth certificate and Medicaid claims data.
• Analysis of 151,464 full-term infants born in Ohio between July 1991 and June 1998.
• Bivariate and multivariate analyses assessed the impact of primary care visits within 21 days of birth on ED visits within 91 days of birth.

Main Results:

• Only 53% of infants had a documented primary care visit within 21 days of birth.
• Twenty-eight percent of infants experienced at least one ED visit within 91 days of birth.
• Early primary care linkage was associated with a 16% increase in the likelihood of ED use, with hospital-based clinics showing a 27% increase.

Conclusions:

• Early primary care linkage did not reduce emergency department (ED) use in early infancy for Medicaid recipients.
• The type of primary care setting, specifically hospital-based clinics, may be associated with increased ED utilization.
• Findings challenge the assumption that early primary care access automatically translates to decreased ED visits in this population.