Pediatric emergency department utilization within a statewide medicaid managed care system.

Abstract

To describe pediatric emergency department (ED) utilization within a Medicaid managed care system and to investigate the association between pediatric ED utilization and the type of medical home. This was a retrospective cohort study, set at Rhode Island's statewide Medicaid managed care program (RIte Care). The study population was a random sample of 2,000 children aged 19 to 35 months at the conclusion of a period of continuous RIte Care enrollment from July 1, 1996, until June 30, 1997. For description of ED utilization, rates of utilization and percentages were calculated. Bivariate and multivariate analyses were used to determine the effect of type of medical home and individual/family characteristics on ED utilization. Logistic regression models were used to determine odds ratios for types of medical home while controlling for sociodemographic factors and practice level variation. Of the 1,988 children who were eligible for analysis, 791 children utilized the ED during the study year at a rate of 68 ED visits/100 person-years. Thirty-one percent of those visits were for injuries/poisonings. Logistic regression analysis demonstrated decreased ED utilization for patients enrolled in a staff-model health maintenance organization (HMO) (OR 0.34; 95% CI = 0.27 to 0.42) or a health center (OR 0.71; 95% CI = 0.53 to 0.95) compared with hospital-based clinics. There was no significant association between the receipt of preventive services and ED utilization. Despite the presence of a defined medical home, ED use was common among preschool children enrolled in the statewide Medicaid managed care program. The type of medical home was an important determinant of ED use in this population.