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Maternal and Child Health Journal

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01-01-2020 | Care

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

Authors: Neera K. Goyal, Courtney M. Brown, Alonzo T. Folger, Eric S. Hall, Judith B. Van Ginkel, Robert T. Ammerman

Published in: Maternal and Child Health Journal | Issue 1/2020

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.

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Title: Adherence to Well-Child Care and Home Visiting Enrollment Associated with Increased Emergency Department Utilization
Authors: Neera K. Goyal
Courtney M. Brown
Alonzo T. Folger
Eric S. Hall
Judith B. Van Ginkel
Robert T. Ammerman
Publication date: 01-01-2020
Publisher: Springer US
Keyword: Care
Published in: Maternal and Child Health Journal / Issue 1/2020
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-019-02821-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Introduction

Methods

Results

Discussion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Discussion

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