 |
|
 |
|
 |
 |
|
 |
 |
 |
 |
 |
 |
 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1 Division of General Pediatrics, The Center for Minority Health Research, University of Maryland, Baltimore, MD
2 Division of General Pediatrics, University of Maryland, Baltimore, MD
3 The Center for Minority Health Research, University of Maryland, Baltimore, MD
Objective. To evaluate the health outcomes of managed care Medicaid children with non-emergent conditions who were not authorized to be seen in the Pediatric Emergency Department (PED) by their primary care provider.
Design. Consecutive case surveillance from 6/29/92 to 2/2/93.
Setting. University based PED (17,500 visits/year) in inner city Baltimore.
Participants. Cases were MAC children denied authorization to be seen for non-emergent conditions in the PED. Age and complaint matched MAC children were selected from the university based Pediatric Ambulatory Center (PAC) and from non-emergent PED visits (PED-seen) in order to compare utilization rates after denial.
Intervention. The Maryland Access to Care (MAC) Medicaid program (started in 12/91) emphasizes primary care and appropriate health care utilization by incorporating the following elements of managed care: assignment to primary care provider, gatekeeping, mandatory enrollment and fee for service.
Methods. Consecutive case surveillance from 6/29/92 to 2/2/93 was used to evaluate the health outcomes of MAC children denied authorization for non-emergent care in a university based PED. One week following denial, a pediatric nurse practitioner contacted the patient's caretaker and the MAC provider to ascertain health outcome. Medicaid claims data was used to compare the six month health care utilization of the denied group to age and complaint matched children seen in the PED (PED-seen) or in a primary care clinic (PAC).
Results. 216 MAC patients were not authorized for a PED visit by their MAC providers. 123 (57%) saw their MAC provider within one week of the denied PED visit. 40 (18%) were not seen because their presenting complaint had resolved completely. No adverse health outcomes occurred because of delay in health care delivery. The subsequent ER utilization rate of the denied group was the same as the PED-seen comparison group, and significantly higher than that of the PAC group (P = .002). The denied group was hospitalized at a significantly higher rate relative to these comparison groups (P = .003).
Conclusions. Diverting Medicaid children classified as non-emergent in an ER to their MAC providers can be a safe practice short-term. However, denial of a PED visit has no impact on subsequent ER utilization by Medicaid participants and may be associated with higher hospitalization rate. Gatekeeping in this setting does not necessarily change the health care seeking behavior of these patients.
Submitted on January 31, 1994
This article has been cited by other articles:
 |
|
 |
|
  C. Wang, M. E. Villar, D. A. Mulligan, and T. Hansen Cost and Utilization Analysis of a Pediatric Emergency Department Diversion Project Pediatrics, November 1, 2005; 116(5): 1075 - 1079. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Guttman, D. R. Zimmerman, and M. S. Nelson The Many Faces of Access: Reasons for Medically Nonurgent Emergency Department Visits Journal of Health Politics Policy and Law, December 1, 2003; 28(6): 1089 - 1120. [Abstract] [PDF]
|
|
|
|
 |
|
 U. R. Kotagal, P. J. Schoettker, H. D. Atherton, R. W. Hornung, D. Bush, W. J. Pomerantz, and C. J. Schubert Relationship Between Early Primary Care and Emergency Department Use in Early Infancy by the Medicaid Population Arch Pediatr Adolesc Med, July 1, 2002; 156(7): 710 - 716. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. E. McNulty, L. C. Hampers, and S. E. Krug Primary Care and Emergency Department Decision Making Arch Pediatr Adolesc Med, November 1, 2001; 155(11): 1266 - 1270. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Guttman, M. S. Nelson, and D. R. Zimmerman When the Visit to the Emergency Department is Medically Nonurgent: Provider Ideologies and Patient Advice Qual Health Res, March 1, 2001; 11(2): 161 - 178. [Abstract] [PDF]
|
|
|
|
|
|
V. Sharma, S. D. Simon, J. M. Bakewell, E. F. Ellerbeck, M. H. Fox, and D. D. Wallace Factors Influencing Infant Visits to Emergency Departments Pediatrics, November 1, 2000; 106(5): 1031 - 1039. [Abstract] [Full Text]
|
|
|
|
 |
|
 B. Berman The Academic Children's Hospital Primary Care Clinic: Responding to tie Challenges of a Changing Health Care Environment Clinical Pediatrics, August 1, 2000; 39(8): 473 - 478. [Abstract] [PDF]
|
|
|
|
|
|
M. D. Piehl, C. J. Clemens, and J. D. Joines "Narrowing the Gap": Decreasing Emergency Department Use by Children Enrolled in the Medicaid Program by Improving Access to Primary Care Arch Pediatr Adolesc Med, August 1, 2000; 154(8): 791 - 795. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Wilson and J. D. Klein Adolescents Who Use the Emergency Department as Their Usual Source of Care Arch Pediatr Adolesc Med, April 1, 2000; 154(4): 361 - 365. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. K. Grossman, L. N. Rich, and C. Johnson Decreasing Nonurgent Emergency Department Utilization by Medicaid Children Pediatrics, July 1, 1998; 102(1): 20 - 24. [Abstract] [Full Text]
|
|
|
|
|
|
A. Gadomski, P. Jenkins, and M. Nichols Impact of a Medicaid Primary Care Provider and Preventive Care on Pediatric Hospitalization Pediatrics, March 1, 1998; 101 (3): e1 - e1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Franco, C. K. Mitchell, and R. M. Buzon Primary Care Physician Access and Gatekeeping: A Key to Reducing Emergency Department Use Clinical Pediatrics, February 1, 1997; 36(2): 63 - 68. [Abstract] [PDF]
|
|
 |
||
|
||
Home | My Pediatrics | Journal Information | Current Issue | Past Issues | Subscriptions & Services | Contact Us Click here for faster international access © 1995 American Academy of Pediatrics. All rights reserved. |
||
|
||
