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Quality of primary care and subsequent pediatric emergency department utilization
David C Brousseau1, Raymond G Hoffmann, Ann B Nattinger
1Department of Pediatrics, Children's Research Institute, Medical College of Wisconsin, CCC 550, 999 N 92nd St, Milwaukee, WI 53226, USA. dbrousse@mcw.edu
Insights
High-quality primary care, particularly family-centeredness and realized access, significantly reduced nonurgent pediatric emergency department visits. Parent reports offer valuable insights into healthcare quality for children.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Quality Improvement
Background:
- Emergency department (ED) utilization for nonurgent pediatric conditions is a significant concern.
- Understanding factors influencing ED use is crucial for optimizing healthcare resource allocation.
- Parental perception of primary care quality is a potential indicator of healthcare access and utilization patterns.
Purpose of the Study:
- To investigate the association between parent-reported high-quality primary care and reduced nonurgent pediatric emergency department (ED) visits.
- To examine specific domains of primary care quality, including family-centeredness, timeliness, and realized access.
- To determine if these associations differ across demographic factors and age groups.
Main Methods:
- Retrospective analysis of prospectively collected data from the Medical Expenditure Panel Survey (2000-2002).
- Assessment of parent-reported primary care quality using composite scores from the Consumer Assessment of Healthcare Providers and Systems survey.
- Statistical adjustment for demographic factors and health status to evaluate the primary outcomes: nonurgent and urgent ED visits.
Main Results:
- High-quality family-centeredness was linked to a 42-49% reduction in nonurgent ED visits for publicly insured children and younger children (< or = 2 years).
- Greater realized access correlated with a 35-56% decrease in nonurgent ED visits across various age groups (3-11, > or = 12 years) and insurance types.
- No significant association was found between timeliness of care and nonurgent ED visits, nor between any quality domain and urgent ED visits.
Conclusions:
- Parent-reported high-quality family-centeredness and realized access in primary care are associated with decreased nonurgent pediatric ED utilization.
- These findings highlight the importance of parental perspectives in assessing healthcare quality.
- Improving primary care quality in these domains may serve as a strategy to reduce unnecessary ED visits in children.
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.
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