Pediatric Emergency Medicine Fellow UPMC Children's Hospital of Pittsburgh UPMC Children's Hospital of Pittsburgh of UPMC Pittsburgh, Pennsylvania, United States
Background: Despite programs to deter low-acuity emergency department (ED) visits, data indicate changes in access, cost, care expectations, and child health have led to decreased primary care visits and increased pediatric ED (PED) visits nationwide over the last 15 years. There is insufficient evidence on the role of enhanced access services (additional outpatient opportunities to receive care from primary care) to decrease low-acuity ED utilization.
Objective: To identify primary care practice level factors (i.e., enhanced access services) associated with variation in PED low-acuity visit rates at the practice level
Design/Methods: Using PED electronic health record data from a tertiary children’s hospital, we identified low-acuity ED visits by children ≤18 years old between January 1, 2018-December 31, 2019 and assigned each visit to the child’s primary care practice. We obtained active patient panel size from individual practices to calculate low-acuity ED visits rates per 100 active patients. Focusing on practices in the surrounding county, we stratified practices into tertiles of low-acuity ED visit rates (high, intermediate, and low). By practice tertile, we compared practice level patient demographics by rank-sum tests and enhanced access services by chi-square tests.
Results: Total PED encounters of 40,472 (by 25,354 unique patients) were attributable to 27 primary care practices (Fig. 1). Practice-level low-acuity ED visit rates ranged from 2 to 79 per 100 patients. Across tertiles, the median percent of low-acuity ED visits occurring during office hours (as opposed to outside of office hours) was highest in the high tertile practices (43.5%) compared to intermediate (41.9%) and low tertile practices (36.8%). Practice-level patient demographics (child age, race, gender) were similar (Table 1). Practices varied in percent of patients insured by Medicaid (median 52% of patients at high tertile practices vs 30% at low tertile practices, p=0.10). Practices in the highest tertile of ED utilization were less likely to have 4 or more evenings of weekday extended hours (11% vs. 55%, p=0.01) or any weekend hours (33% vs. 89%, p=0.03) (Table 2). Across all tertiles, similar proportion of practices reported same-day walk-in hours (89%, p=0.62). Conclusion(s): Variation exists in enhanced access services throughout a county-wide sample of pediatric primary care practices. Practices with lower low-acuity PED utilization rates were more likely to offer four or more evenings of extended weekday hours and any weekend hours.
Authors/Institutions: Mark R. Hincapie, UPMC Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United States; Srinivasan Suresh, UPMC Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United States; Kaila Alston, University of Pittsburgh, Pittsburgh, Pennsylvania, United States; Gabriella A. Butler, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States; Kristin Ray, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
