title: Parental perceptions of avoidability of their child's emergency department visit.
abstract: OBJECTIVE
  To identify the factors associated with paediatric emergency department (ED) visits and parental perceptions of the avoidability of their child's ED visit.
  
  
  METHODS
  Cross-sectional study by performing secondary analysis of 2010-2011 Iowa Child and Family Household Health Survey data.
  
  
  METHODS
  State-wide representative population-based sample of families with at least one child in the state of Iowa in the USA.
  
  
  METHODS
  Among the eligible households, 2386 families completed the survey, yielding a cooperation rate of 80%.
  Presence of a medical home.
  
  
  METHODS
  Child visiting an ED in the past year; parents believing that ED care could have been provided in a primary-care setting.
  
  
  RESULTS
  Among children who needed medical care in the past year, 26% visited an ED. Younger children, non-Hispanic black children, non-Hispanic others, children whose parents were not married, children who were from food-insecure households and had poorer health status were more likely to visit an ED. Having a medical home was not associated with ED visits (OR=0.80, 95% CI 0.61 to 1.04), even after stratifying by the child's health status. About 69% of parents who took their child to an ED agreed that ED care could have been provided in a primary-care setting. Parents of children with public insurance, those who were not referred to the ED and those who could not get routine care appointments were more likely to report a primary-care preventable ED visit.
  
  
  CONCLUSIONS
  The majority of parents believed that paediatric ED visits could be avoided if adequate primary-care alternatives were available. Expanding access to primary care could lead to a reduction in avoidable ED visits by children.
authors.affiliation: Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, Iowa, USA Public Policy Center, University of Iowa, Iowa City, Iowa, USA.
authors.forename: Astha
authors.identifier: http://orcid.org/0000-0001-9191-6978
authors.initials: A
authors.lastname: Singhal
authors.affiliation: Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, Iowa, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Caplan
authors.affiliation: Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Jones
authors.affiliation: Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, Iowa, USA Public Policy Center, University of Iowa, Iowa City, Iowa, USA.
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Kuthy
authors.affiliation: Public Policy Center, University of Iowa, Iowa City, Iowa, USA.
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Momany
authors.affiliation: Department of Emergency Medicine, College of Medicine, University of Iowa, Iowa City, Iowa, USA.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Buresh
authors.affiliation: Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, Iowa, USA Public Policy Center, University of Iowa, Iowa City, Iowa, USA.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Damiano
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D007223:Infant; D007348:Insurance, Health; D007484:Iowa; D016015:Logistic Models; D008297:Male; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors
keywords: emergency care systems, admission avoidance; paediatrics, paediatric emergency medicine; primary care