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Is continuity of care preserved in children who utilize the pediatric emergency department?
P M Vivier1, W J Lewander, S H Block
1Division of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
Insights
Children visiting a pediatric emergency department (ED) have similar follow-up care rates as those using primary care. This suggests ED visits do not necessarily disrupt continuity of care for inner-city families seeking medical attention.
Area of Science:
- Pediatric Healthcare
- Continuity of Care
- Health Services Research
Background:
- Inner-city families frequently utilize multiple healthcare sites for nonemergent medical needs.
- This fragmented care pattern raises concerns regarding consistent and continuous healthcare for children.
- Pediatric emergency departments are often accessed for nonemergent issues, impacting primary care relationships.
Purpose of the Study:
- To evaluate whether children receiving care at a pediatric emergency department return to their primary care site for recommended follow-up.
- To compare the follow-up care compliance rates between children seen in a pediatric emergency department and those who visited their primary care site directly.
Main Methods:
- A 4-week study observed two groups of neighborhood health center children: those visiting the pediatric emergency department and "walk-ins" at health centers.
- Analysis included all visits with a documented recommendation for a follow-up appointment within 6 weeks at the health center.
Main Results:
- Of 87 pediatric emergency department visits with follow-up recommendations, 76% (66 cases) resulted in a subsequent health center visit within 6 weeks.
- Similarly, 76% (111 of 146 cases) of "walk-in" visits with follow-up recommendations led to a return visit within the 6-week period.
Conclusions:
- Revisit rates were comparable between children who received care in the pediatric emergency department and those who used the primary care site.
- Compliance with follow-up care recommendations appears similar regardless of whether the initial care was sought at a pediatric emergency department or a primary care site.
Objective:
Inner city families often use multiple sites for nonemergent medical care, including the pediatric emergency department. This practice raises concerns about continuity of care. The present study examined one aspect of continuity of care: Do children who receive care in a pediatric emergency department return to their primary care site so that appropriate follow up may be obtained?
Methods:
Over a 4-week period two groups of neighborhood health center children were studied: Those who sought care at the pediatric emergency department and those who were "walk-ins" at the health centers. All visits during the 4-week study period which resulted in a recommendation for the child to be seen within 6 weeks at the health centers were included in the analysis.
Results:
During the study period there were 87 patient visits to the pediatric emergency department with a documented physician instruction to be seen at their health center within 6 weeks. In 66 (76%) of the cases, the patient was seen at one of the health centers during the 6 weeks following the pediatric emergency department visit. There were 146 "walk-in" visits to the health centers with a documented physician instruction to be seen again at the health centers during the 6 weeks following the walk-in visit. In 111 (76%) of the cases, the patient was seen during the 6-week period.
Conclusion:
Our study shows that revisit rates were comparable for the two groups. We conclude that the rate of compliance with follow-up recommendations is similar for those who utilized the pediatric emergency department versus those who used the primary care site.
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