Child/Adolescent Health

Quality and accessible primary care is linked to fewer emergency department visits by Medicaid-insured children

Low-income children insured by State Medicaid programs are far more likely than other children to end up in the hospital emergency department (ED) for nonurgent care. Quality pediatric primary care can reduce both urgent and nonurgent ED visits, suggests a new study. David C. Brousseau, M.D., M.S., of the Medical College of Wisconsin, and colleagues studied ED visits by 5,468 children insured by the Wisconsin Medicaid program. They linked these ED visits to parents' scores in three domains of their child's primary care: family centeredness, timeliness, and realized access on the 2002 and 2004 Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey.

Overall, 28 percent of the children visited the ED during the followup year; 59 percent of those ED visits were classified as nonurgent. A total of 79 percent of parents rated family centeredness, 84 percent rated realized access, and 69 percent rated timeliness of primary care as high quality. High-quality family centeredness was associated with 27 percent fewer nonurgent ED visits, but no lowering of the urgent visit rate. High-quality timeliness was associated with 18 percent fewer nonurgent and urgent visits. Finally, high-quality realized access was associated with 27 percent fewer nonurgent visits and 33 percent fewer urgent visits.

A higher level of parental educational attainment and better parent-reported child health status were both linked to significantly fewer urgent and nonurgent ED visits. Children 12 years and older showed consistently higher urgent ED use, while children 2 years and younger showed consistently greater nonurgent ED use. Child race/ethnicity was not significant after accounting for other factors. Finally, not having an identified primary care provider was associated with greater nonurgent ED use. The study was supported by the Agency for Healthcare Research and Quality (HS15482).

For more information about CAHPS®, go to https://cahps.ahrq.gov.

More details are in "Primary care quality and subsequent emergency department utilization for children in Wisconsin Medicaid," by Dr. Brousseau, Marc H. Gorelick, M.D., M.S.C.E., Raymond G. Hoffman, Ph.D., and others, in the January/February 2009 Academic Pediatrics 9, pp. 33-39.

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