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Regional after-hours urgent care provided by a tertiary children's hospital
Louis C Hampers1, S Glenn Faries, Steven R Poole
1Children's Hospital Pediatric Urgent Care Network, University of Colorado School of Medicine, Denver, Colorado 80218, USA. hampers.lou@tchden.org
Insights
A new pediatric urgent care network (PUCN) provides convenient after-hours care for children, meeting primary care pediatrician (PCP) needs. The network demonstrates high PCP satisfaction and patient usage, though cost-effectiveness varies by site.
Area of Science:
- Pediatric emergency medicine
- Community health networks
- Urgent care services
Background:
- Ambulatory pediatric emergency department (ED) visits present challenges for families.
- Primary care pediatricians (PCPs) seek alternatives to extended office hours or community hospital EDs for urgent patient needs.
Purpose of the Study:
- To describe a regional, community-based pediatric urgent care network (PUCN).
Main Methods:
- The PUCN comprised four models: pediatric ED faculty, general pediatricians in EDs, freestanding urgent care centers, and hospital-based urgent care centers.
- Physician staffing was managed by a tertiary children's hospital.
- Data included billing records and a questionnaire sent to 55 PCP practices.
Main Results:
- Over 37,000 visits occurred in 2001, with minor trauma, ear complaints, and viral illnesses as primary reasons.
- Most visits (79%) were for low to moderate complexity (CPT levels 2 and 3).
- PCPs reported high usage (81%), good communication (85%), and overall satisfaction (99%) with the PUCN.
Conclusions:
- The PUCN successfully meets regional PCP needs for after-hours pediatric urgent care.
- Cost-effectiveness is influenced by billing, collection rates, and staffing models.
- The network offers a viable alternative to traditional emergency department or extended office hours care.
Background:
Ambulatory presentation to a tertiary pediatric emergency department (ED) is not convenient for many families. Yet many primary care pediatricians (PCPs) desire after-hours urgent care for their patients as an alternative to extended office hours or care by general emergency medicine providers at community hospitals.
Objective:
To describe a regional, community-based pediatric urgent care network (PUCN).
Methods:
The PUCN consists of 4 models: 1) pediatric emergency medicine faculty in a community hospital ED; 2) general pediatricians in a community hospital ED; 3) general pediatricians in a freestanding urgent care center; and 4) general pediatricians in a community hospital-based urgent care center. Physician staffing at all 4 sites is managed by our tertiary children's hospital. Billing records were reviewed and a questionnaire was mailed to 55 PCP practices in our metro area.
Results:
Year 2001 visits totaled 37 143. Minor trauma, ear complaints, and viral illnesses accounted for 70% of visits. Current Procedural Terminology codes for visits, reflecting complexity levels 1, 2, 3, 4, and 5 were billed at the following frequency: 1%, 35%, 44%, 17% and 3%, respectively. A total of 2.2% of visits required admission or transfer. Mean collection rates ranged from 37% to 68% across the 4 sites. Break-even average hourly patient volumes ranged from 1.1 (site 4) to 1.9 (sites 1 and 3). A total of 110 PCPs, representing all 55 practices, responded to the questionnaire: 81% reported their patients used the PUCN often, 85% felt that communication between the PUCN and their practice was good, and 99% reported overall satisfaction with the network.
Conclusions:
The PUCN effectively addresses the needs of regional PCPs; however, the cost-effectiveness of such a program depends on billing practices, local collection rates, and site-specific staffing patterns.