 |
|
Relationship Between Early Primary Care and Emergency Department Use in Early Infancy by the Medicaid Population
Uma R. Kotagal, MBBS, MSc;
Pamela J. Schoettker, MS;
Harry D. Atherton, BSEE, MS;
Richard W. Hornung, DrPH;
Donna Bush, MSW, LSW;
Wendy J. Pomerantz, MD, MS;
Charles J. Schubert, MD
Arch Pediatr Adolesc Med. 2002;156:710-716.
Objective To examine the relationship between the use and type of primary care
and visits to the emergency department (ED) in early infancy by healthy infants
who are Medicaid recipients.
Design A population-based cohort study using a database linking birth certificate
data to Medicaid claims.
Participants A total of 151 464 full-term infants born in Ohio to mothers receiving
Medicaid from July 1, 1991, through June 30, 1998.
Main Outcome Measures The primary outcome of interest was the occurrence of an ED visit within
91 days of the neonate's birth. Bivariate and multivariate analyses were performed
to determine the effect of early linkage with primary care (within 21 days
of birth) on ED use in early infancy.
Results Only 53% of the infants had a documented primary care visit within 21
days of birth. Twenty-eight percent of infants had at least 1 ED visit within
91 days of birth and 9% had more than 1 visit. The mean age of the neonate
at the first ED visit was 39.7 days. Fifteen percent of primary care visits
within 21 days of birth occurred at a hospital-based primary care clinic.
After adjusting for maternal, infant, and residency characteristics and temporal
differences, early primary care linkage was associated with a 16% increase
in the likelihood of ED use. When the primary care visit occurred in a hospital-based
primary care clinic, it was associated with a 27% increase in the likelihood
of ED use.
Conclusion Contrary to our expectations, early primary care linkage did not result
in a decreased risk of ED use.
From the Center for Health Policy and Clinical Effectiveness (Dr Kotagal,
Ms Schoettker, and Mr Atherton), the Divisions of Neonatology (Dr Kotagal)
and Emergency Medicine (Drs Pomerantz and Schubert), Children's Hospital Medical
Center, and the Institute of Health Policy and Health Services Research (Drs
Kotagal and Hornung), University of Cincinnati, Cincinnati, Ohio; and the
Bureau of Health Plan Policy, Ohio Department of Job and Family Services,
Columbus (Ms Bush).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Cost-Effectiveness of Postnatal Home Nursing Visits for Prevention of Hospital Care for Jaundice and Dehydration
Paul et al.
Pediatrics 2004;114:1015-1022.
ABSTRACT
| FULL TEXT
Influence of Medicaid Managed Care Enrollment on Emergency Department Utilization by Children
Dombkowski et al.
Arch Pediatr Adolesc Med 2004;158:17-21.
ABSTRACT
| FULL TEXT
|
