title: Evaluating the Impact of the Healthy Beginnings System of Care Model on Pediatric Emergency Department Utilization.
abstract: OBJECTIVE
  The aim of this study was to evaluate whether enrollment in the Healthy Beginnings System of Care (SOC) model is associated with a decrease in emergency department (ED) visits among children aged 6 months to 5.5 years.
  
  
  METHODS
  A retrospective, longitudinal study of ED utilization was conducted among children enrolled in the Healthy Beginnings SOC model between February 2011 and May 2013. Using medical records obtained from a children's hospital in Atlanta, the rate of ED visits per quarter was examined as the main outcome. A multilevel, multivariate Poisson model, with family- and child-level random effects, compared ED utilization rates before and after enrollment. Adjusted rate ratios and 95% confidence intervals were calculated after controlling for sociodemographic confounders.
  
  
  RESULTS
  The effect of SOC enrollment on the rate of ED visits differed by income level of the primary parent. The rate of ED visits after enrollment was not significantly different than the rate of ED visits before enrollment for children whose primary parent had an annual income of less than $5000 (P = 0.298), $20,000 to $29,999 (P = 0.199), or $30,000 or more (P = 0.117). However, for the children whose primary parent's annual income was $5000 to $19,999, the rate of ED visits after enrollment was significantly higher than the rate of ED visits before enrollment (adjusted rate ratio, 1.48; 95% confidence interval, 1.17-1.87).
  
  
  CONCLUSIONS
  Enrollment in the SOC model does not appear to decrease the rate of ED visits among enrolled children. Additional strategies, such as education sessions on ED utilization, are needed to reduce the rate of ED utilization among SOC-enrolled children.
authors.affiliation: From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Cheryl H
authors.initials: CH
authors.lastname: Tan
authors.forename: Julie
authors.initials: J
authors.lastname: Gazmararian
mesh_terms: D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013221:State Health Plans / Q000706:statistics & numerical data*