Primary Care Spatial Density and Nonurgent Emergency Department Utilization: A New Methodology for Evaluating Access to Care.
OBJECTIVE: To determine the spatial and demographic characteristics of pediatric patients who make nonurgent visits (NUVs) to an urban pediatric emergency department (ED). We hypothesized that the rate of NUVs would be inversely associated with the spatial density of primary care providers (PCPs). M...
| Published in: | Academic Pediatrics Vol. 13; no. 3; pp. 278 - 286 |
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| Main Authors: | , , , , , , |
| Format: | research tables/charts Journal Article |
| Published: |
Elsevier B.V.
May/Jun2013
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107944125&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 107944125 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 18762859 8NBK jtl: Academic Pediatrics issn: 18762859 maglogo: N pubinfo: dt: May/Jun2013 vid: 13 iid: 3 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 107944125 87730396 87730396 10.1016/j.acap.2013.02.006 107944125 ppf: 278 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Primary Care Spatial Density and Nonurgent Emergency Department Utilization: A New Methodology for Evaluating Access to Care. aug: au: Mathison, David J. Chamberlain, James M. Cowan, Nuala M. Engstrom, Ryan N. Fu, Linda Y. Shoo, Anthony Teach, Stephen J. affil: Department of Pediatrics and Emergency Medicine, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC sug: subj: Health Services Accessibility In Infancy and Childhood Emergency Care Utilization Spatial Behavior Human District of Columbia Retrospective Design Multivariate Analysis Linear Regression Infant Child, Preschool Child Adolescence Odds Ratio Confidence Intervals Data Analysis Software Geographic Factors Male Female Descriptive Statistics Infant: 1-23 months Child, Preschool: 2-5 years Child: 6-12 years Adolescent: 13-18 years Male Female ab: OBJECTIVE: To determine the spatial and demographic characteristics of pediatric patients who make nonurgent visits (NUVs) to an urban pediatric emergency department (ED). We hypothesized that the rate of NUVs would be inversely associated with the spatial density of primary care providers (PCPs). METHODS: A retrospective, cross-sectional analysis was conducted for all visits to Washington, DCs principal pediatric ED between 2003 and 2006. NUVs were defined by a unique algorithm combining resource allocation, ambulatory-sensitive diagnoses, and billing data. Multivariate linear regression analysis was used to determine the association of PCP density and demographic variables on the spatial rate of NUVs. RESULTS: Over the 4-year period, 35.1% (52,110) of the 148,314 ED visits by Washington, DC, residents were nonurgent. NUVs were most associated with neighborhood median household income <$40,000 and low spatial density of PCPs. For every 1-unit increase in PCP density, the spatial rate of NUVs decreased by 9%. The odds of a visit being nonurgent were significantly higher for African Americans and Hispanics than for whites (odds ratio [OR] 2.4, 95% confidence interval [CI] 2.19-2.64; and OR 2.6, 95% CI 2.36-2.86, respectively), for patients using public insurance versus private (OR 1.46, 95% CI 1.42-1.50), and for patients age <5 years (OR 2.66, 95% CI 2.60-2.72). CONCLUSIONS: Low spatial density of primary care is strongly associated with nonurgent ED utilization. Improving spatial distribution of primary care may decrease ED misuse and improve access to the medical home. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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