Published online June 1, 2007
PEDIATRICS Vol. 119 No. 6 June 2007, pp. 1131-1138 (doi:10.1542/peds.2006-3518)
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ARTICLE

Quality of Primary Care and Subsequent Pediatric Emergency Department Utilization

David C. Brousseau, MD, MSa,b, Raymond G. Hoffmann, PhDb, Ann B. Nattinger, MD, MPHb,c, Glenn Flores, MDa,b,d, Yinghua Zhang, MSNb and Marc Gorelick, MD, MSCEa,b

a Department of Pediatrics, Children's Research Institute
b Department of Population Health
c Department of Medicine, Patient Care and Outcomes Research Center
d Center for the Advancement of Underserved Children, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin

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 ≤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 ≥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.

Key Words: quality of health care • child • utilization • emergency care

Abbreviations: ED—emergency department • CAHPS—Consumer Assessment of Healthcare Providers and Systems • MEPS—Medical Expenditure Panel Survey • IRR—incidence rate ratio • CI—confidence interval

Accepted Jan 22, 2007.