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. 2020 Oct;55(5):671-680.
doi: 10.1111/1475-6773.13308. Epub 2020 Jun 27.

Ambulatory quality, special health care needs, and emergency department or hospital use for US children

Ryan J Coller  1 , Michelle M Kelly  1 , Daniel J Sklansky  1 , Kristin A Shadman  1 , Mary L Ehlenbach  1 , Christina B Barreda  1 , Paul J Chung  2 , Qianqian Zhao  1 , Marshall Bruce Edmonson  1
Affiliations

Ambulatory quality, special health care needs, and emergency department or hospital use for US children

Ryan J Coller et al. Health Serv Res. 2020 Oct.

Abstract

Objective: This study examined family-reported ambulatory care quality and its association with emergency department and hospital utilization, and how these relationships differed across levels of medical complexity.

Data sources: The 2006-2013 Medical Expenditure Panel Survey (MEPS).

Study design: Secondary analysis of MEPS data. Variables fitting the National Quality Measures Clearinghouse clinical quality measures domain framework were selected. Exploratory factor analysis grouped ambulatory quality into 12 access, experience, or process measures. Weighted negative binomial regression stratified by health status identified associations between ambulatory quality and ED visits or hospitalizations.

Data collection: 41,497 children ≤18 years were included. The 5-item special health care needs (SHCN) screener categorized health status as complex, less complex, or no SHCN.

Principal findings: Weighted SHCN proportions were 1.6 Percent complex, 18.2 Percent less complex, and 80.0 Percent no SHCN. Mean ED visits were 130 and 335 visits/1000 children/year for no/ complex SHCN, respectively. Mean hospitalizations were 20 and 175 hospitalizations/1000 children/year for no/complex SHCN, respectively. ED visits were associated with 8 of 12 quality measures for no/less complex SHCN. For example, usually/always receiving needed care right away was associated with 22 Percent lower ED visit rate (95% CI 0.64-0.96). Hospitalizations were associated with 4 of 12 quality measures for less complex SHCN. In complex SHCN, associations between ambulatory quality and ED/hospital use were weak and inconsistent.

Conclusions: Ambulatory quality may best predict ED and hospital use for children with no or less complex SHCN. Whether and how ambulatory care predicts emergency and hospital care in complex SHCN remains an important question.

Keywords: ambulatory care; emergency service; hospitalization; quality of health care.

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Conflict of interest statement

The authors have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1
Figure 1
Categorical Ambulatory Access and Process Measures by Health Status Category in US Children. SHCN indicates Special Health Care Needs. Shown are the weighted percent distributions of categorical ambulatory quality measures, stratified by health status category. Experience and process measures that were continuous (ie, patient‐centered communication, timely routine screening, and overall rating of care) are reported in Results
Figure 2
Figure 2
Associations between Ambulatory Access, Experience, and Process Measures and Emergency Department Visits by Health Status Category in US Children. IRR, Incident Rate Ratio. Shown are weighted negative binomial regressions of emergency department visits on ambulatory measures, stratified by health status and adjusted for age, gender, primary language, race/ethnicity, income, insurance, and panel number. IRR (95% CI) <1 indicates better quality is associated with fewer emergency department visits. Asterisks indicate P < .05. IRR estimates and 95% CI are available in the Appendix S1.
Figure 3
Figure 3
Associations between ambulatory access, experience, and process measures and hospitalizations by health status category in US children. IRR, Incident Rate Ratio. Shown are weighted multivariate negative binomial regressions of hospitalizations on ambulatory measures, stratified by health status and adjusted for age, gender, primary language, race/ethnicity, income, insurance, and panel number. IRR (95% CI) < 1 indicates better quality is associated with fewer hospitalizations. Asterisks indicate P < .05. IRR estimates and 95% CI are available in the Appendix S1
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