Potential Cost Savings of Decreased Emergency Department Visits Through Increased Continuity in a Pediatric Medical Home

McBurney, Patricia G.; Simpson, Kit N.; Darden, Paul M.

doi:10.1367/a03-069r.1

Cited by 22 publications

(17 citation statements)

References 19 publications

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“…[11][12][13] None of these were interventional studies, so how exactly to improve continuity of care is unclear. Once the patient is in the ED, there have been mixed results in trying to improve subsequent continuity of care with the PCP.…”

Section: Discussionmentioning

confidence: 99%

Distances to Emergency Department and to Primary Care Provider’s Office Affect Emergency Department Use in Children

Ludwick

Warden

et al. 2009

Academic Emergency Medicine

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Objectives: Patients of all ages use emergency departments (EDs) for primary care. Several studies have evaluated patient and system characteristics that influence pediatric ED use. However, the issue of proximity as a predictor of ED use has not been well studied. The authors sought to determine whether ED use by pediatric Medicaid enrollees was associated with the distance to their primary care providers (PCPs), distance to the nearest ED, and distance to the nearest children's hospital.Methods: This historical cohort study included 26,038 children age 18 and under, assigned to 332 primary care practices affiliated with a Medicaid health maintenance organization (HMO). Predictor variables were distance from the child's home to his or her PCP site, distance from home to the nearest ED, and distance from home to the nearest children's hospital. The outcome variable was each child's ED use. A negative binomial model was used to determine the association between distance variables and ED use, adjusted for age, sex, and race, plus medical and primary care site characteristics previously found to influence ED use. Distance variables were divided into quartiles to test for nonlinear associations.Results: On average, children made 0.31 ED visits ⁄ person ⁄ year. In the multivariable model, children living greater than 1.19 miles from the nearest ED had 11% lower ED use than those living within 0.5 miles of the nearest ED (risk ratio [RR] = 0.89, 95% CI = 0.81 to 0.99). Children living between 1.54 and 3.13 miles from their PCPs had 13% greater ED use (RR = 1.13, 95% CI = 1.03 to 1.24) than those who lived within 0.7 miles of their PCP.Conclusions: Geographical variables play a significant role in ED utilization in children, confirming the importance of system-level determinants of ED use and creating the opportunity for interventions to reduce geographical barriers to primary care.ACADEMIC EMERGENCY MEDICINE 2009; 16:411-417 ª

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Section: Discussionmentioning

confidence: 99%

Distances to Emergency Department and to Primary Care Provider’s Office Affect Emergency Department Use in Children

Ludwick

Warden

et al. 2009

Academic Emergency Medicine

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“…18 Many have argued that mental health needs, especially for relatively common conditions, also should be addressed in a primary care-based medical home. Although having a medical home has been shown to improve the quality of care for CSHCN [20][21][22][23] and decrease costs, 24 the impact of having a medical home for children with mental health conditions is less clear; therefore, we sought to examine whether having a medical home was associated with fewer unmet needs for children with ADHD. Furthermore, we wished to compare the impact of having a medical home for children with ADHD with that for children with a prototypical physical health condition: asthma.…”

mentioning

confidence: 99%

Does Connection to Primary Care Matter for Children With Attention-Deficit/Hyperactivity Disorder?

Toomey¹,

Finkelstein

Kuhlthau

2008

Pediatrics

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“…11,12 Other families would have made an urgent care visit. Such visits are reimbursed at a modest premium above office and telemedicine visits, but, because they occur outside the medical home, they are also likely (along with ED visits) to be associated with more testing than those within the medical home.…”

Section: Health System Advantagesmentioning

confidence: 99%

Patient Evaluation of an Acute Care Pediatric Telemedicine Service in Urban Neighborhoods

McIntosh

Cirillo

Wood

et al. 2014

Telemedicine and e-Health

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Background: Telemedicine has enhanced care for children with illness in Rochester, NY, since May 2001, enabling 13,568 acute illness visits through December 2013. Prior findings included high parent satisfaction with childcare-and school-based telemedicine (''school telemedicine'') and potential to replace 85% of office visits for illness. Urban neighborhood telemedicine (''neighborhood telemedicine'') was designed to offer convenient care for illness episodes that school telemedicine often cannot serve because illness arises when children are at home or symptoms preclude attendance. This study was designed to characterize health problems prompting neighborhood telemedicine use and to assess parent perceptions of its value. Materials and Methods: A parent satisfaction instrument was developed with input from parents and providers. Neighborhood telemedicine was initiated in January 2009 and totaled 1,362 visits through November 2013. During a 29-month survey period through January 2012, 3,871 acute illness telemedicine visits were completed, 908 (23.5%) of them via neighborhood telemedicine. Instruments were completed for 392 (43.2%) of the 908 visits. Results: Neighborhood telemedicine comprised 27% of all telemedicine visits during the year of peak neighborhood activity. Almost all survey respondents were satisfied or highly satisfied with neighborhood visits (97.6%) and endorsed greater convenience than alternatives (94.5%). Conclusions: Family preferences and the high value placed on neighborhood telemedicine suggest such service is important, especially in health systems driven by patient values. Service provided by neighborhood telemedicine holds potential to meet a large demand for care of acute childhood illness. Financing reform to support patient-centered care (e.g., bundled payments) should encompass sustainable business models for this service.

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Potential Cost Savings of Decreased Emergency Department Visits Through Increased Continuity in a Pediatric Medical Home

Cited by 22 publications

References 19 publications

Distances to Emergency Department and to Primary Care Provider’s Office Affect Emergency Department Use in Children

Distances to Emergency Department and to Primary Care Provider’s Office Affect Emergency Department Use in Children

Does Connection to Primary Care Matter for Children With Attention-Deficit/Hyperactivity Disorder?

Patient Evaluation of an Acute Care Pediatric Telemedicine Service in Urban Neighborhoods

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