Child/Adolescent Health

Family-centered, high quality primary care is linked to fewer nonurgent emergency department visits by children

From 37 to 60 percent of children's visits to the emergency department (ED) each year are for nonurgent conditions. This causes ED crowding as well as fragmented care for children. A new study underscores one way to reduce nonurgent ED visits-high-quality, family-centered primary care. In family-centered care, the clinician explains things so that patients understand them. The clinician also shows respect for the family, spends enough time, and listens carefully. In the study, parent-reported family-centered care was associated with 42 percent fewer nonurgent ED visits for publicly insured children and 49 percent fewer visits for children age 2 years and younger.

Greater realized access (child's ability to receive necessary care and referrals), as reported by parents, was associated with 44 percent fewer nonurgent ED visits for children 3 to 11 years of age and 56 percent fewer visits for children 12 and older. It was also associated with 37 and 35 percent, respectively, fewer nonurgent ED visits for publicly and privately insured children. There was no significant association between timeliness of care and nonurgent ED use.

These findings suggest that parent reports of primary care health care quality can complement other information on health care quality, concludes David C. Brousseau, M.D., M.S., of the Medical College of Wisconsin. He and coinvestigators analyzed data from the 2000-2001 and 2001-2002 Medical Expenditure Panel Survey. They examined parental reports on the quality of primary care with respect to family-centeredness, timeliness, and realized access. Of the 8,823 children included, 70 percent of parents rated family-centeredness, 88 percent rated realized access, and 56 percent rated timeliness as high quality.

The study was supported in part by the Agency for Healthcare Research and Quality (HS15482). See "Quality of primary care and subsequent pediatric emergency department utilization," by Dr. Brousseau, Raymond G. Hoffmann, Ph.D., Ann B. Nattinger, M.D., M.P.H., and others, in the June 2007 Pediatrics 119(6), pp. 1131-1138.

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