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Primary care quality and subsequent emergency department utilization for children in Wisconsin Medicaid
David C Brousseau1, Marc H Gorelick, Raymond G Hoffmann
1Department of Pediatrics, Children's Research Institute, Medical College of Wisconsin, 999 N 92nd Street, Milwaukee, WI 53226, USA. dbrousse@mcw.edu
Insights
Parent-reported primary care quality, including timeliness and access, is linked to fewer emergency department (ED) visits for children in Medicaid. High-quality care reduces both nonurgent and urgent ED use.
Area of Science:
- Health Services Research
- Pediatric Health
- Health Equity
Background:
- Children enrolled in Medicaid exhibit high emergency department (ED) visit rates.
- Assessing patient-reported quality of care is crucial, yet its impact on ED utilization for high-risk children is understudied.
Purpose of the Study:
- To investigate the association between parent-reported primary care quality and subsequent ED utilization among children covered by Medicaid.
Main Methods:
- A retrospective cohort study of 5468 children enrolled in Wisconsin Medicaid.
- Parents completed surveys on primary care quality (family centeredness, timeliness, realized access).
- ED visit rates (nonurgent and urgent) were extracted from claims data for the year post-survey.
Main Results:
- High-quality family centeredness correlated with a 27% reduction in nonurgent ED visits.
- High-quality timeliness was associated with 18% lower rates for both nonurgent and urgent ED visits.
- High-quality realized access showed significant reductions in both nonurgent (27%) and urgent (33%) ED visits.
Conclusions:
- Parent-reported primary care quality, specifically timeliness and realized access, is associated with reduced ED utilization in publicly insured children.
- Improvements in family centeredness, timeliness, and realized access may decrease nonurgent ED visits, while timeliness and access also lower urgent ED visits.
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.
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