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, DC's 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.
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, DC's 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.
Authors: Sheryl Davies; Ellen Schultz; Maria Raven; Nancy Ewen Wang; Carol L Stocks; Mucio Kit Delgado; Kathryn M McDonald Journal: Health Serv Res Date: 2017-03-30 Impact factor: 3.402
Authors: M C Watson; J Ferguson; G R Barton; V Maskrey; A Blyth; V Paudyal; C M Bond; R Holland; T Porteous; T H Sach; D Wright; S Fielding Journal: BMJ Open Date: 2015-02-18 Impact factor: 2.692
Authors: Michael M Dinh; Saartje Berendsen Russell; Kendall J Bein; Dane R Chalkley; David Muscatello; Richard Paoloni; Rebecca Ivers Journal: BMJ Open Date: 2016-05-10 Impact factor: 2.692