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.
Similar content being viewed by others
References
Abdus, S., & Selden, T. M. (2013). Adherence with recommended well-child visits has grown, but large gaps persist among various socioeconomic groups. Health Affairs,32(3), 508–515.
Anugu, M., Braksmajer, A., Huang, J., Yang, J., Ladowski, K. L., & Pati, S. (2017). Enriched medical home intervention using community health worker home visitation and ED use. Pediatrics,139(5), e20161849.
Beck, A. F., Tschudy, M. M., Coker, T. R., Mistry, K. B., Cox, J. E., Gitterman, B. A., et al. (2016). Determinants of health and pediatric primary care practices. Pediatrics,137(3), e20153673.
Benchimol, E. I., Smeeth, L., Guttmann, A., Harron, K., Moher, D., Petersen, I., et al. (2015). The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement. PLoS Med,12(10), e1001885.
Brousseau, T., & Sharieff, G. Q. (2006). Newborn emergencies: The first 30 days of life. Pediatric Clinics of North America,53(1), 69–84.
Butun, A., Linden, M., Lynn, F., & McGaughey, J. (2019). Exploring parents’ reasons for attending the emergency department for children with minor illnesses: A mixed methods systematic review. Emergency Medicine Journal,36(1), 39–46.
Davis, T., Meyer, A., Beste, J., & Batish, S. (2018). Decreasing low acuity pediatric emergency room visits with increased clinic access and improved parent education. Journal of the American Board of Family Medicine,31(4), 550–557.
Folger, A. T., Bowers, K. A., Dexheimer, J. W., Sa, T., Hall, E. S., Van Ginkel, J. B., et al. (2017). Evaluation of early childhood home visiting to prevent medically attended unintentional injury. Annals of Emergency Medicine,70(3), 302–310.
Goyal, N. K., Ammerman, R. T., Massie, J. A., Clark, M., & Van Ginkel, J. B. (2016). Using quality improvement to promote implementation and increase well child visits in home visiting. Child Abuse and Neglect,53, 108–117.
Goyal, N. K., Folger, A. T., Sucharew, H. J., Brown, C. M., Hall, E. S., Van Ginkel, J. B., et al. (2018). Primary care and home visiting utilization patterns among at-risk infants. Journal of Pediatrics,198, 240–246.
Hadland, S. E., & Long, W. E. (2014). A systematic review of the medical home for children without special health care needs. Maternal and Child Health Journal,18(4), 891–898.
Hagan, J. F., Shaw, J. S., & Duncan, P. M. (Eds.). (2017). Bright futures: Guidelines for health supervision of infants, children and adolescents (4th ed.). Elk Grove Village, IL: American Academy of Pediatrics.
Health Resources and Services Administration. (2010). Maternal, infant, and early childhood home visiting program. Retrieved from http://mchb.hrsa.gov/programs/homevisiting.
Kercsmar, C. M., Beck, A. F., Sauers-Ford, H., Simmons, J., Wiener, B., Crosby, L., et al. (2017). Association of an asthma improvement collaborative with health care utilization in Medicaid-insured pediatric patients in an urban community. JAMA Pediatrics,171(11), 1072–1080.
Koball, H., & Jiang, Y. (2018). Basic facts about low-income children: Children under 18 years, 2016. Retrieved from http://www.nccp.org/publications/pub_1194.html.
Kroner, E. L., Hoffmann, R. G., & Brousseau, D. C. (2010). Emergency department reliance: A discriminatory measure of frequent emergency department users. Pediatrics,125(1), 133–138.
Lambert, L. (2016). Collaboration of home visiting and primary care clinicians. Current Problems in Pediatric and Adolescent Health Care,46(4), 130–131.
Lee, H. C., Bardach, N. S., Maselli, J. H., & Gonzales, R. (2014). Emergency department visits in the neonatal period in the United States. Pediatric Emergency Care,30(5), 315–318.
Marshall, A., Altman, D. G., Royston, P., & Holder, R. L. (2010). Comparison of techniques for handling missing covariate data within prognostic modelling studies: A simulation study. BMC Medical Research Methodology,10, 7.
Martsolf, G., Fingar, K. R., Coffey, R., Kandrack, R., Charland, T., Eibner, C., et al. (2017). Association between the opening of retail clinics and low-acuity emergency department visits. Annals of Emergency Medicine,69(4), 397–403.
Matone, M., O’Reilly, A. L., Luan, X., Localio, A. R., & Rubin, D. M. (2012). Emergency department visits and hospitalizations for injuries among infants and children following statewide implementation of a home visitation model. Maternal and Child Health Journal,16(9), 1754–1761.
McDermott, K. W., Stocks, C., & Freeman, W. J. (2018). Overview of pediatric emergency department Visits, 2015. Statistical brief. Healthcare Cost and Utilization Project. Retrieved January 16, 2019, from https://www.hcup-us.ahrq.gov/reports/statbriefs/sb242-Pediatric-ED-Visits-2015.pdf.
Minkovitz, C. S., Hughart, N., Strobino, D., Scharfstein, D., Grason, H., Hou, W., et al. (2003). A practice-based intervention to enhance quality of care in the first 3 years of life: The Healthy Steps for Young Children Program. JAMA,290(23), 3081–3091.
Morrison, A. K., Schapira, M. M., Gorelick, M. H., Hoffmann, R. G., & Brousseau, D. C. (2014). Low caregiver health literacy is associated with higher pediatric emergency department use and nonurgent visits. Academic Pediatric,14(3), 309–314.
National Committee for Quality Assurance. (2019). Patient-Centered Medical Home Recognition. Retrieved September 5, 2019, from http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH.aspx.
Paradis, H. A., Belknap, A., O’Neill, K., Baggett, S., & Minkovitz, C. S. (2018). Coordination of early childhood home visiting and health care providers. Children and Youth Services Review,85, 202–210.
Pethe, K., Baxterbeck, A., Rosenthal, S. L., & Stockwell, M. S. (2019). Why parents use the emergency department despite having a medical home. Clinical Pediatrics,58(1), 95–99.
Pomerantz, W. J., Schubert, C. J., Atherton, H. D., & Kotagal, U. R. (2002). Characteristics of nonurgent emergency department use in the first 3 months of life. Pediatric Emergency Care,18(6), 403–408.
Radcliffe, J., Schwarz, D., & Zhao, H. (2013). The MOM Program: Home visiting in partnership with pediatric care. Pediatrics,132(Suppl 2), S153–S159.
Rasooly, I. R., Mullins, P. M., Alpern, E. R., & Pines, J. M. (2014). US emergency department use by children, 2001–2010. Pediatric Emergency Care,30(9), 602–607.
Riney, L. C., Brokamp, C., Beck, A. F., Pomerantz, W. J., Schwartz, H. P., & Florin, T. A. (2018). Emergency medical services utilization is associated with community deprivation in children. Prehospital Emergency Care,17, 1–8.
Rushton, F. E., Byrne, W. W., Darden, P. M., & McLeigh, J. (2015). Enhancing child safety and well-being through pediatric group well-child care and home visitation: The Well Baby Plus Program. Child Abuse and Neglect,41, 182–189.
Sarver, J. H., Cydulka, R. K., & Baker, D. W. (2002). Usual source of care and nonurgent emergency department use. Academic Emergency Medicine,9(9), 916–923.
Zickafoose, J. S., DeCamp, L. R., & Prosser, L. A. (2013). Association between enhanced access services in pediatric primary care and utilization of emergency departments: A national parent survey. The Journal of Pediatrics,163(5), 1389–1395.
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors have no conflicts of interest relevant to this article to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Goyal, N.K., Brown, C.M., Folger, A.T. et al. Adherence to Well-Child Care and Home Visiting Enrollment Associated with Increased Emergency Department Utilization. Matern Child Health J 24, 73–81 (2020). https://doi.org/10.1007/s10995-019-02821-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-019-02821-5