Emergency Department UsePrimary Care Quality and Subsequent Emergency Department Utilization for Children in Wisconsin Medicaid
Section snippets
Study Population and Source of Data
This is a retrospective cohort analysis linking the results of cross-sectional CAHPS surveys evaluating quality of primary care to subsequent ED utilization as determined by analysis of administrative Medicaid data.
The study population combines 2 cohorts of children, one cohort from 2002 and the other from 2004. In the fall of 2002 and again in the fall of 2004, the Wisconsin Department of Health and Family Services sent CAHPS surveys to randomly selected enrollees in the Wisconsin Managed Care
Results
A total of 5582 children had completed CAHPS surveys, of which 114 were excluded for incomplete subsequent enrollment. The final cohort of children was very similar in age and gender to the population of all children enrolled in the Managed Care Medicaid program as determined by comparison to enrollment data from the Department of Health and Family Services. Of the 5468 children in the final cohort, 1540 children (28.2%) made a total of 2792 ED visits during the follow-up year, yielding an
Discussion
The study findings indicate that specific domains that comprise high parent-reported quality of primary care for children are associated with lower subsequent nonurgent and urgent visit rates to the ED. High-quality family centeredness, timeliness, and realized access were all associated with lower subsequent nonurgent utilization of the ED for children, while high-quality timeliness and realized access were also associated with a lower subsequent urgent visit rate to the ED.
The findings from
Conclusions
Parent-reported high-quality timeliness, family centeredness, and realized access of primary care for a child are associated with significantly lower rates of subsequent nonurgent ED visits while high-quality realized access and timeliness are also associated with lower rates of urgent ED visits. Whether the ED visits are parent reported or are based on administrative data, the relationship between these domains of care and subsequent utilization is similar, thus strengthening the argument that
Acknowledgments
This work was supported by a grant (K08 HS015482-01A1) to Dr Brousseau from the Agency for Healthcare Research and Quality. The authors report no conflicts of interest or corporate sponsors.
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