Evaluating the Impact of the Healthy Beginnings System of Care on Pediatric Emergency Department Utilization Público
Tan, Cheryl H. (2014)
Abstract
Objective
To evaluate whether enrollment in the Healthy Beginnings System of Care (SOC) is associated with a decrease in total emergency department (ED) visits among children aged six months to 5.5 years.
MethodsThis is a retrospective, longitudinal study of ED utilization among children enrolled in the Healthy Beginnings SOC between February 2011 and May 2013. The SOC employs a Health Navigator who works with low income families to improve healthcare access through connecting them with health insurance and primary care physicians, making referrals for health or developmental concerns, and providing health education (e.g. well-child visits and immunizations). Using ED medical records obtained from a local children's hospital, total ED visits per quarter was examined as the main outcome. A multi-level, multivariate Poisson model, with family- and child-level random effects to control for correlation, was used to calculate the effect of enrollment on the rate of ED utilization for children enrolled in the SOC. Adjusted rate ratios (aIRR) and 95% confidence intervals were calculated after controlling for confounders such as child's age, enrollment age and parent's income.
Results
The effect of SOC enrollment on the rate of ED visits differed by income level of the primary parent. Adjusting for confounders, the rate of ED visits post-enrollment was not significantly different than the rate of ED visits pre-enrollment for children whose primary parent's annual income was under $5,000 (aIRR= 1.12, 95% CI: 0.90 - 1.40), for children whose primary parent's annual income was $20,000-$29,999 (aIRR = 1.36, 95% CI: 0.85 - 2.16), and for children whose primary parent's annual income was $30,000 and over (aIRR = 0.55, 95% CI: 0.26 - 1.17). However, for the children whose primary parent's annual income was $5,000 to $19,999, the rate of ED visits post-enrollment was significantly higher compared to the rate of ED visits pre-enrollment (aIRR = 1.48, 95% CI: 1.17 - 1.87).
Conclusion
Enrollment does not appear to decrease the rate of ED visits among children in the Healthy Beginnings SOC. Additional strategies, such as specific education sessions on ED utilization, are needed by the SOC to reduce the rate of ED utilization among enrolled children.
Table of Contents
Introduction 1
Background and Literature Review 2
Factors associated with non-urgent pediatric ED utilization 2
Interventions to reduce non-urgent pediatric ED visits 4
Background on Healthy Beginnings System of Care 7
Methods 9
Study Objective 9
Study Population 9
Healthy Beginnings SOC Program 10
Data Collection 11
Data Measures 13
Data Analysis 14
Results 16
Descriptive Frequencies of Study Population 16
Descriptive Frequencies of ED Visits 17
Bivariate Analyses 18
Multivariate Analyses 19
Discussion 21
Strengths and limitations 22
Future Directions 24
References 26
Tables 32
Figures 43
Appendices 44
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