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Matern Child Health J. 2019 Nov 11. doi: 10.1007/s10995-019-02821-5. [Epub ahead of print]

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

Author information

1
Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA. neera.goyal@nemours.org.
2
Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA. neera.goyal@nemours.org.
3
Department of Pediatrics, Nemours/Thomas Jefferson University, 833 Chestnut St., Ste. 300, Philadelphia, PA, 19107, USA. neera.goyal@nemours.org.
4
Nationwide Children's Hospital, Columbus, OH, USA.
5
Department of Pediatrics, The Ohio State University, Columbus, OH, USA.
6
Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
7
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
8
Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
9
Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

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:

Emergency department; Home visiting; Infant; Medical home; Well-child care

PMID:
31712949
DOI:
10.1007/s10995-019-02821-5

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