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. 2018 Aug 10;3(5):e097.
doi: 10.1097/pq9.0000000000000097. eCollection 2018 Sep-Oct.

Association between Practice Participation in a Pediatric-focused Medical Home Learning Collaborative and Reduction of Preventable Emergency Department Visits by Publicly-insured Children in Massachusetts

Paul B Kirby  1 , Anna L Christensen  2 , Louise Bannister  1 , Valerie Konar  1
Affiliations

Association between Practice Participation in a Pediatric-focused Medical Home Learning Collaborative and Reduction of Preventable Emergency Department Visits by Publicly-insured Children in Massachusetts

Paul B Kirby et al. Pediatr Qual Saf. .

Abstract

Introduction: This study evaluates the impact of practice participation in a pediatric patient-centered medical home learning collaborative on preventable emergency department (ED) visits among children in MassHealth (Massachusetts Medicaid/Children's Health Insurance Program).

Methods: Claims and enrollment data were extracted for child MassHealth members (aged 3-18) comprising 2 groups: members enrolled in a group of 13 child-serving practices that participated in an intensive, 29-month long patient-centered medical home learning collaborative (intervention group), and members enrolled in a group of 12 comparison practices with roughly similar panel size, type, and geographic location (comparison group). Preventable ED visits were identified using a modified version of the New York University ED algorithm. Two analyses were then conducted: (1) a repeat cross-sectional analysis among children enrolled in intervention or comparison group practices during baseline (first half of 2011) and follow-up (second half of 2013) periods; and (2) a longitudinal analysis among a subset of children enrolled for the full study period (2011-2013). Both analyses tested whether the effect of the intervention differed for children with versus without chronic conditions (effect modification).

Results: Preventable ED visits declined from baseline to follow-up among children in both intervention and comparison practices. In the cross-sectional analysis, the decrease was the same in both practice groups, and for children with versus without chronic conditions. The longitudinal analysis shows a statistically significantly greater decrease among children with chronic conditions enrolled in the intervention practices (P = 0.02).

Conclusion: Children with chronic conditions might receive the greatest benefit from receiving care in a medical home setting.

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Figures

Fig. 1.
Fig. 1.
Percentage of children in longitudinal sample with an unnecessary ED visit (n = 10,069).
Fig. 2.
Fig. 2.
Percentage of children in longitudinal sample with an unnecessary ED visit, by children’s chronic condition status (n = 10,069).
See this image and copyright information in PMC

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