title: Quality of primary care and subsequent pediatric emergency department utilization.
abstract: OBJECTIVE
  Our objective was to determine whether parent-reported, high-quality primary care was associated with decreased nonurgent pediatric emergency department utilization.
  
  
  METHODS
  A retrospective analysis of prospectively collected data for a cohort of children from the 2000-2001 and 2001-2002 Medical Expenditure Panel Survey panels was performed. Baseline parent-reported quality of primary care with respect to family-centeredness, timeliness, and realized access (a measure of the child's ability to receive necessary care and referrals) was assessed by using composite scores from the Consumer Assessment of Healthcare Providers and Systems survey. The primary outcomes were the numbers of subsequent nonurgent and urgent emergency department visits per child.
  
  
  RESULTS
  Of 8823 children included, 70.0% rated family-centeredness, 88.2% rated realized access, and 55.6% rated timeliness as high quality. After adjustment for demographic factors and health status, high-quality family-centeredness was associated with a 42% reduction in nonurgent emergency department visits for publicly insured children and a 49% reduction for children < or = 2 years of age. Greater realized access was associated with a 44% reduction in nonurgent emergency department visits for children 3 to 11 years of age and a 56% reduction for children > or = 12 years of age. Greater realized access was also associated with decreased nonurgent emergency department visits for publicly and privately insured children (37% and 35%, respectively). There was no significant association between timeliness and nonurgent emergency department utilization, nor was any quality-of-care domain associated with urgent emergency department utilization.
  
  
  CONCLUSIONS
  Parent-reported, high-quality family-centeredness and a high level of realized access to primary care were associated with decreased subsequent nonurgent emergency department visits for children. Parent reports of health care quality in these domains provide important complementary information on health care quality.
authors.affiliation: Department of Pediatrics, Children's Research Institute, Medical College of Wisconsin, CCC 550, 999 N 92nd St, Milwaukee, WI 53226, USA. dbrousse@mcw.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Brousseau
authors.forename: Raymond G
authors.initials: RG
authors.lastname: Hoffmann
authors.forename: Ann B
authors.initials: AB
authors.lastname: Nattinger
authors.forename: Glenn
authors.initials: G
authors.lastname: Flores
authors.forename: Yinghua
authors.initials: Y
authors.lastname: Zhang
authors.forename: Marc
authors.initials: M
authors.lastname: Gorelick
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011320:Primary Health Care / Q000592:standards* / Q000639:trends; D011446:Prospective Studies; D011787:Quality of Health Care / Q000592:standards* / Q000639:trends; D012189:Retrospective Studies