Cost and Utilization Analysis of a Pediatric Emergency Department Diversion Project

Abstract

Analysis from the first year of this pilot program demonstrates that by providing enhanced, coordinated, primary care access to Medicaid children, the utilization of the ED was significantly lowered among healthy children, whereas the overall cost of care remained the same.

Pediatric Emergency Department Management Benefits From Appropriate Early Redirection of Nonurgent Visits

“…This finding, most likely reflecting shortness of urban primary care facilities during evening and weekend hours (compared with office hours), should be carefully considered when labeling visits as nonurgent or inappropriate. 22 Easily accessible primary care centers during the day and out-of-office hours could be one solution to decrease nonurgent ED visits 12,[23][24][25] because several studies suggest that shortage of daytime appointments at primary care centers is one of the main reasons for coming to the PED with nonurgent complaints. 8,26,27 However, only one available primary care facility open during out-of-office hours in the present study did not seem to be sufficient to meet the needs of the parents, where some of them may be bound to seek medical care for their children while not at work themselves.…”

“…11 Different approaches to nonurgent seeking patterns have been reported in American studies with various levels of success. [12][13][14] However, no such pediatric studies have been made in northern Europe, where the health care system is primarily based on universal health insurance (instead of a mixture of Medicaid and private insurance) and where pediatric hospital and primary care visits, at least in Sweden, are free of charge up to the age of 18 years.…”

Associations Between Practice-Reported Medical Homeness and Health Care Utilization Among Publicly Insured Children

“…For example, access to primary care has been linked to decreased ED use among children. [27][28][29][30] The NCQA selfassessment contains 7 items that measure "Access and Continuity," including access during office hours, afterhours access, and electronic access, whereas the MHI-RSF includes only one item for "Communication/Access," which does not specifically reference after-hours access or electronic access. It is possible that variation in access to care was not well measured in the NC/SC sample.…”

The Role of Medical Home in Emergency Department Use for Children With Developmental Disabilities in the United States

“…17,18 Higher exposures to primary care services emphasizing family centeredness, timeliness, and coordinated care are all associated with decreased numbers of visits to the ED among typically developing children on Medicaid. [19][20][21] Medical home attributes such as patient-care planning, care coordination, and 24-hour mobile-phone access are effective in enhancing families' capability to manage their children's conditions in the community. 22,23 However, gaps remain in the understanding of the impact of medical home on reducing episodic emergency department use (EDU) for children with DD.…”