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J Pediatr. 2013 Nov;163(5):1389-95.e1-6. doi: 10.1016/j.jpeds.2013.04.050. Epub 2013 Jun 5.

Association between enhanced access services in pediatric primary care and utilization of emergency departments: a national parent survey.

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Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI; Mathematica Policy Research, Ann Arbor, MI. Electronic address:



To measure the prevalence of enhanced access services in pediatric primary care and to assess whether enhanced access services are associated with lower emergency department (ED) utilization.


Internet-based survey of a national sample of parents (n = 820, response rate 41%). We estimated the prevalence of reported enhanced access services and ED use in the prior 12 months. We then used multivariable negative binomial regression to assess associations between enhanced access services and ED use.


The majority of parents reported access to advice by telephone during office hours (80%), same-day sick visits (79%), and advice by telephone outside office hours (54%). Less than one-half of parents reported access to their child's primary care office on weekends (47%), after 5:00 p.m. on any night (23%), or by email (13%). Substantial proportions of parents reported that they did not know if these services were available (7%-56%, depending on service). Office hours after 5:00 p.m. on ≥ 5 nights a week was the only service significantly associated with ED utilization in multivariable analysis (adjusted incidence rate ratio: 0.51 [95% CI 0.28-0.92]).


The majority of parents report enhanced access to their child's primary care office during office hours, but many parents do not have access or do not know if they have access outside of regular office hours. Extended office hours may be the most effective practice change to reduce ED use. Primary care practices should prioritize the most effective enhanced access services and communicate existing services to families.


CSHCN; Children with special health care needs; ED; Emergency department; IRR; Incidence rate ratio

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