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Adherence to Well-Child Care and Home Visiting Enrollment Associated with Increased Emergency Department Utilization

  • Neera K. GoyalEmail author
  • Courtney M. Brown
  • Alonzo T. Folger
  • Eric S. Hall
  • Judith B. Van Ginkel
  • Robert T. Ammerman
Article

Abstract

Introduction

Pediatric primary care and home visiting programs seek to reduce health disparities and promote coordinated health care use. It is unclear whether these services impact high-cost, emergency department (ED) utilization. We evaluated the association of well-child care (WCC) and home visiting with ED visit frequency for children < 1 year with an established medical home.

Methods

Retrospective cohort study using linked administrative data for infants ≥ 34 weeks’ gestation from 2010 to 2014, within a multisite, academic primary care system. Latent class analysis characterized longitudinal patterns of WCC. Multivariable negative binomial regression models tested the independent association between WCC patterns and home visiting enrollment with ED visits.

Results

Among 10,363 infants, three WCC latent classes were identified: “Adherent” (83.4% of the cohort), “Intermediate” (9.7%), and “Decreasing adherence” (7.0%). Sixty-one percent of the sample had ≥ 1 ED visit in the first 12 months of life, and 73% of all ED visits were triaged as non-urgent. There was a significant interaction effect between WCC pattern and insurance status. Among Medicaid-insured infants, “Intermediate” and “Decreasing adherence” WCC patterns were associated with a lower incident rate of ED visits compared with the “Adherent” pattern (incident rate ratios (IRR) 0.88, p = 0.03 and 0.79, p < 0.001 respectively); this effect was not observed among privately-insured infants. Home visiting enrollment was independently associated with a higher rate of ED visits (IRR 1.24, p < 0.001).

Discussion

Among infants with an established medical home, adherence to recommended WCC and home visiting enrollment was associated with greater ED use for non-urgent conditions.

Keywords

Well-child care Home visiting Emergency department Medical home Infant 

Notes

Funding

The authors have no financial relationships relevant to this article to disclose. This work was supported by Grant R40 MC29447 through the US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau.

Compliance with Ethical Standards

Conflicts of interest

The authors have no conflicts of interest relevant to this article to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Neera K. Goyal
    • 1
    • 2
    • 9
    Email author
  • Courtney M. Brown
    • 3
    • 4
  • Alonzo T. Folger
    • 5
    • 6
  • Eric S. Hall
    • 5
    • 7
  • Judith B. Van Ginkel
    • 5
  • Robert T. Ammerman
    • 5
    • 8
  1. 1.Department of PediatricsSidney Kimmel Medical College of Thomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Nemours/Alfred I. duPont Hospital for ChildrenWilmingtonUSA
  3. 3.Nationwide Children’s HospitalColumbusUSA
  4. 4.Department of PediatricsThe Ohio State UniversityColumbusUSA
  5. 5.Department of PediatricsUniversity of CincinnatiCincinnatiUSA
  6. 6.Division of Biostatistics and EpidemiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  7. 7.Perinatal InstituteCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  8. 8.Division of Behavioral Medicine and Clinical PsychologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  9. 9.Department of PediatricsNemours/Thomas Jefferson UniversityPhiladelphiaUSA

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