Family-Centered Care Can Decrease Hospitalization & ED Use

Abstract

Research Article| October 01 2011 Family-Centered Care Can Decrease Hospitalization & ED Use AAP Grand Rounds (2011) 26 (4): 45. https://doi.org/10.1542/gr.26-4-45 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Family-Centered Care Can Decrease Hospitalization & ED Use. AAP Grand Rounds October 2011; 26 (4): 45. https://doi.org/10.1542/gr.26-4-45 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: family-centered care, quality of care, parent report measures, emergency service, hospital Source: Raphael JL, Mei M, Brousseau DC, et al. Associations between quality of primary care and health care use among children with special health care needs. Arch Pediatr Adolesc Med. 2011; 165(5): 399– 404; doi: https://doi.org/10.1001/archpediatrics.2011.33Google Scholar Researchers from Baylor College of Medicine in Houston, TX, and the Medical College of Wisconsin conducted a secondary analysis of the 2004–2005 and 2005–2006 Medical Expenditure Panel Surveys (MEPS) to determine the relationship between parent-reported quality of care and emergency department (ED) visits and hospitalizations in children with special health care needs (CSHCN). MEPS is a large-scale, prospective two-year survey of individuals and families, administered by the Agency for Healthcare Research and Quality (AHRQ). MEPS collects data on health care utilization, expenditures, and insurance coverage. Consumer Assessment of Healthcare Providers and Systems (CAHPS) questions are used to assess parental experiences with care. The authors identified CSHCN using the CSHCN Screener tool. Question groupings into quality of care domains and composite scores for parental survey responses were provided by AHRQ. The authors then dichotomized the composite scores, which were averages of Likert scale responses, into high quality versus low quality. Regression analyses were used to describe the associations between scores and the primary outcomes – the number of reported ED visits and hospitalizations. The eligible population totaled 1,591 CSHCN, of whom 85% were between 4 and 17 years of age. Over 97% of the children were insured. Family-centeredness, timeliness, and realized access were the domains of care rated as high quality by 68.3%, 51.5%, and 80.4% of the parents, respectively. Low quality family-centeredness was associated with increased subsequent nonurgent ED visits (incident rate ratio [IRR] 2.24; 95% CI, 1.32–3.80), but there was no association found between any quality domain and subsequent urgent ED visits. For hospitalizations, low quality family-centered care and realized access were significantly associated with more subsequent hospitalizations in privately insured children (IRR 3.87; 95% CI, 1.23–12.13). There were no associations between reported quality of care and hospitalizations in publicly insured children. The authors conclude that parent-reported low quality family-centered care correlates with increased ED utilization and hospitalization in CSHCN. This work builds upon one author’s prior research that demonstrated a link between low quality family-centeredness and nonurgent ED visits in a general population of children.1 Strengths of the approach used in this study include the nationally representative sample and longitudinal survey (MEPS) and a validated questionnaire (CAHPS) to assess family experiences of care. Although the patient population and parental reports are likely generalizable, the associations with ED visits and hospitalizations were modified by variables such as insurance status and urgency of care that will need further exploration. An accompanying editorial appropriately points out that these results do not yet inform practice change and “more granular measurement tools” will likely be needed if we are to tease out the specific interactions that drive improved health outcomes.2 Nonetheless, this work adds to a small but growing body of... You do not currently have access to this content.