Understanding Frequent Emergency Room Use by Medicaid-Insured Children with Asthma: A Combined Quantitative and Qualitative Study

Abstract

Background: Medicaid-insured asthmatic children frequently use emergency rooms (ERs). The reasons are unclear and have predominantly been studied in inner-city populations.Methods: We used billing data and focus groups to clarify reasons for frequent ER use by Medicaidinsured children with asthma living in rural areas and 23 towns in Kansas.Results: High ER utilization was concentrated in a small percentage of provider practices and children with asthma. Parents expressed strong preference for primary care treatment, and identified real or perceived difficulties in using primary care as the principal reasons for ER use. Difficulties included trouble contacting primary care physicians or obtaining urgent appointments, limited continuity of care, practice systems poorly adapted to patient needs, a perception that physicians preferred patients to use emergency services, and difficulties in obtaining medications. Parents were not aware of preventive measures or case management but reported high interest in these. Parents did not recall provider discussion of asthma risk factors/preventive strategies during primary care visits, although all children with high ER utilization had multiple risk factors, including exposure to high levels of household smoking.Conclusions

Community- versus Individual-Level Indicators to Identify Pediatric Health Care Need

“…Among the explanations are cultural differences about the perceived utility of preventive care, the 24 hour per day access of emergency rooms, and the perceptions of dissatisfaction due to poor communication, disrespect, and racial/ethnic discrimination by health care provider. [35][36][37][38][39][40][41] …”

“…Results from QOL studies not only have characterized the impact of an illness on the quality of life, but also the fundamental role that the family_s financial status plays on the quality of life. 37 Consequently, it is likely that QOL might identify differences in the quality of life between income groups, even though that is not their initial intent. But QOL are individual-level indicators.…”

Management and Outcomes for Children with Pyloric Stenosis Stratified by Hospital Type

“…This increased use of the ER is closely tied to reduced access to a regular source of care, especially primary care providers. Besides difficulties in obtaining urgent advice or appointments, parents frequently had difficulties in transport, childcare, or work release that impeded using the primary care office as the principal site of asthma care [13]. This mechanism could certainly be at play in our study, since less than 60% of patients at our city hospital received an US on the day of admission.…”

“…Medicaid beneficiaries make almost 20% of all ER visits and, in particular, Medicaid children are noted to have rising rates of ER use [12]. Fredrickson et al found that ER use was concentrated in a subgroup of children with half of all visits made by 17% of the Medicaid-insured children who used any emergency or hospital services for asthma [13]. This increased use of the ER is closely tied to reduced access to a regular source of care, especially primary care providers.…”

Impact of Follow-Up by The Primary Care Or Specialist Physician on Pediatric Asthma Outcomes after An Emergency Department Visit: The Case of Montreal, Canada

“…29,30 Zorc et al 31 found that organizational barriers to seeing PCP (such as lack of convenient appointments or prolonged waits in PCP office) were factors associated with follow-up after a pediatric ED visit for asthma.…”