Primary Care Spatial Density and Nonurgent Emergency Department Utilization: A New Methodology for Evaluating Access to Care
Abstract Objective To determine the spatial and demographic characteristics of pediatric patients who make nonurgent visits (NUVs) to an urban pediatric emergency department (ED). We hypothesized that the rate of NUVs would be inversely associated with the spatial density of primary care providers (...
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| Veröffentlicht in: | Academic pediatrics 2013-05, Vol.13 (3), p.278-285 |
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| creator | Mathison, David J., MD, MBA Chamberlain, James M., MD Cowan, Nuala M., MS Engstrom, Ryan N., PhD Fu, Linda Y., MD, MS Shoo, Anthony, BS Teach, Stephen J., MD, MPH |
| description | Abstract Objective To determine the spatial and demographic characteristics of pediatric patients who make nonurgent visits (NUVs) to an urban pediatric emergency department (ED). We hypothesized that the rate of NUVs would be inversely associated with the spatial density of primary care providers (PCPs). Methods A retrospective, cross-sectional analysis was conducted for all visits to Washington, DC’s principal pediatric ED between 2003 and 2006. NUVs were defined by a unique algorithm combining resource allocation, ambulatory-sensitive diagnoses, and billing data. Multivariate linear regression analysis was used to determine the association of PCP density and demographic variables on the spatial rate of NUVs. Results Over the 4-year period, 35.1% (52,110) of the 148,314 ED visits by Washington, DC, residents were nonurgent. NUVs were most associated with neighborhood median household income |
| doi_str_mv | 10.1016/j.acap.2013.02.006 |
| format | Article |
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We hypothesized that the rate of NUVs would be inversely associated with the spatial density of primary care providers (PCPs). Methods A retrospective, cross-sectional analysis was conducted for all visits to Washington, DC’s principal pediatric ED between 2003 and 2006. NUVs were defined by a unique algorithm combining resource allocation, ambulatory-sensitive diagnoses, and billing data. Multivariate linear regression analysis was used to determine the association of PCP density and demographic variables on the spatial rate of NUVs. Results Over the 4-year period, 35.1% (52,110) of the 148,314 ED visits by Washington, DC, residents were nonurgent. NUVs were most associated with neighborhood median household income <$40,000 and low spatial density of PCPs. For every 1-unit increase in PCP density, the spatial rate of NUVs decreased by 9%. The odds of a visit being nonurgent were significantly higher for African Americans and Hispanics than for whites (odds ratio [OR] 2.4, 95% confidence interval [CI] 2.19–2.64; and OR 2.6, 95% CI 2.36–2.86, respectively), for patients using public insurance versus private (OR 1.46, 95% CI 1.42–1.50), and for patients age <5 years (OR 2.66, 95% CI 2.60–2.72). Conclusions Low spatial density of primary care is strongly associated with nonurgent ED utilization. Improving spatial distribution of primary care may decrease ED misuse and improve access to the medical home.</description><identifier>ISSN: 1876-2859</identifier><identifier>EISSN: 1876-2867</identifier><identifier>DOI: 10.1016/j.acap.2013.02.006</identifier><identifier>PMID: 23680346</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Child ; Child, Preschool ; Cross-Sectional Studies ; District of Columbia ; emergency department use ; Emergency Service, Hospital - utilization ; geographic information systems ; Geography ; health care delivery/access ; health disparities ; Health Services Accessibility - statistics & numerical data ; Health Services Misuse - statistics & numerical data ; Healthcare Disparities - statistics & numerical data ; Humans ; Infant ; Linear Models ; Multivariate Analysis ; Neonatal and Perinatal Medicine ; Odds Ratio ; Pediatrics ; Physicians, Primary Care - statistics & numerical data ; Retrospective Studies ; Urban Population</subject><ispartof>Academic pediatrics, 2013-05, Vol.13 (3), p.278-285</ispartof><rights>Academic Pediatric Association</rights><rights>2013 Academic Pediatric Association</rights><rights>Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-36e9fe17f4270f38c987cef9dd2714f8398909895104eb8bf379ee8cddc9a1ff3</citedby><cites>FETCH-LOGICAL-c411t-36e9fe17f4270f38c987cef9dd2714f8398909895104eb8bf379ee8cddc9a1ff3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.acap.2013.02.006$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23680346$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mathison, David J., MD, MBA</creatorcontrib><creatorcontrib>Chamberlain, James M., MD</creatorcontrib><creatorcontrib>Cowan, Nuala M., MS</creatorcontrib><creatorcontrib>Engstrom, Ryan N., PhD</creatorcontrib><creatorcontrib>Fu, Linda Y., MD, MS</creatorcontrib><creatorcontrib>Shoo, Anthony, BS</creatorcontrib><creatorcontrib>Teach, Stephen J., MD, MPH</creatorcontrib><title>Primary Care Spatial Density and Nonurgent Emergency Department Utilization: A New Methodology for Evaluating Access to Care</title><title>Academic pediatrics</title><addtitle>Acad Pediatr</addtitle><description>Abstract Objective To determine the spatial and demographic characteristics of pediatric patients who make nonurgent visits (NUVs) to an urban pediatric emergency department (ED). We hypothesized that the rate of NUVs would be inversely associated with the spatial density of primary care providers (PCPs). Methods A retrospective, cross-sectional analysis was conducted for all visits to Washington, DC’s principal pediatric ED between 2003 and 2006. NUVs were defined by a unique algorithm combining resource allocation, ambulatory-sensitive diagnoses, and billing data. Multivariate linear regression analysis was used to determine the association of PCP density and demographic variables on the spatial rate of NUVs. Results Over the 4-year period, 35.1% (52,110) of the 148,314 ED visits by Washington, DC, residents were nonurgent. NUVs were most associated with neighborhood median household income <$40,000 and low spatial density of PCPs. For every 1-unit increase in PCP density, the spatial rate of NUVs decreased by 9%. The odds of a visit being nonurgent were significantly higher for African Americans and Hispanics than for whites (odds ratio [OR] 2.4, 95% confidence interval [CI] 2.19–2.64; and OR 2.6, 95% CI 2.36–2.86, respectively), for patients using public insurance versus private (OR 1.46, 95% CI 1.42–1.50), and for patients age <5 years (OR 2.66, 95% CI 2.60–2.72). Conclusions Low spatial density of primary care is strongly associated with nonurgent ED utilization. Improving spatial distribution of primary care may decrease ED misuse and improve access to the medical home.</description><subject>Adolescent</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Cross-Sectional Studies</subject><subject>District of Columbia</subject><subject>emergency department use</subject><subject>Emergency Service, Hospital - utilization</subject><subject>geographic information systems</subject><subject>Geography</subject><subject>health care delivery/access</subject><subject>health disparities</subject><subject>Health Services Accessibility - statistics & numerical data</subject><subject>Health Services Misuse - statistics & numerical data</subject><subject>Healthcare Disparities - statistics & numerical data</subject><subject>Humans</subject><subject>Infant</subject><subject>Linear Models</subject><subject>Multivariate Analysis</subject><subject>Neonatal and Perinatal Medicine</subject><subject>Odds Ratio</subject><subject>Pediatrics</subject><subject>Physicians, Primary Care - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Urban Population</subject><issn>1876-2859</issn><issn>1876-2867</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUFvFCEUx4nR2Lr6BTwYjl52hGF2Bowx2ayrNqnVpPZMWOaxsjLDCEzNGD98mW7toQcPhBf4_R_h9xB6SUlBCa3fHAql1VCUhLKClAUh9SN0SnlTL0teN4_v65U4Qc9iPGSAcV4_RSclqzlhVX2K_n4LtlNhwhsVAF8OKlnl8Afoo00TVn2LL3w_hj30CW87mAs95ftBhdTNh1fJOvsnx3z_Fq_xBfzGXyD98K13fj9h4wPeXis3ZqLf47XWECNO_va95-iJUS7Ci7t9ga4-br9vPi_Pv34626zPl7qiNC1ZDcIAbUxVNsQwrgVvNBjRtmVDK8OZ4ILktaKkgh3fGdYIAK7bVgtFjWEL9PrYdwj-1wgxyc5GDc6pHvwYJWUrRipGhMhoeUR18DEGMHI4CpKUyNm6PMjZupytS1LKWeoCvbrrP-46aO8j_zRn4N0RgPzLawtBRm2zSWhtAJ1k6-3_-79_ENfO9lYr9xMmiAc_hj77k1TGHJCX89znsVNGCGG8YTeepalY</recordid><startdate>20130501</startdate><enddate>20130501</enddate><creator>Mathison, David J., MD, MBA</creator><creator>Chamberlain, James M., MD</creator><creator>Cowan, Nuala M., MS</creator><creator>Engstrom, Ryan N., PhD</creator><creator>Fu, Linda Y., MD, MS</creator><creator>Shoo, Anthony, BS</creator><creator>Teach, Stephen J., MD, MPH</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130501</creationdate><title>Primary Care Spatial Density and Nonurgent Emergency Department Utilization: A New Methodology for Evaluating Access to Care</title><author>Mathison, David J., MD, MBA ; Chamberlain, James M., MD ; Cowan, Nuala M., MS ; Engstrom, Ryan N., PhD ; Fu, Linda Y., MD, MS ; Shoo, Anthony, BS ; Teach, Stephen J., MD, MPH</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-36e9fe17f4270f38c987cef9dd2714f8398909895104eb8bf379ee8cddc9a1ff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Cross-Sectional Studies</topic><topic>District of Columbia</topic><topic>emergency department use</topic><topic>Emergency Service, Hospital - utilization</topic><topic>geographic information systems</topic><topic>Geography</topic><topic>health care delivery/access</topic><topic>health disparities</topic><topic>Health Services Accessibility - statistics & numerical data</topic><topic>Health Services Misuse - statistics & numerical data</topic><topic>Healthcare Disparities - statistics & numerical data</topic><topic>Humans</topic><topic>Infant</topic><topic>Linear Models</topic><topic>Multivariate Analysis</topic><topic>Neonatal and Perinatal Medicine</topic><topic>Odds Ratio</topic><topic>Pediatrics</topic><topic>Physicians, Primary Care - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>Urban Population</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mathison, David J., MD, MBA</creatorcontrib><creatorcontrib>Chamberlain, James M., MD</creatorcontrib><creatorcontrib>Cowan, Nuala M., MS</creatorcontrib><creatorcontrib>Engstrom, Ryan N., PhD</creatorcontrib><creatorcontrib>Fu, Linda Y., MD, MS</creatorcontrib><creatorcontrib>Shoo, Anthony, BS</creatorcontrib><creatorcontrib>Teach, Stephen J., MD, MPH</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Academic pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mathison, David J., MD, MBA</au><au>Chamberlain, James M., MD</au><au>Cowan, Nuala M., MS</au><au>Engstrom, Ryan N., PhD</au><au>Fu, Linda Y., MD, MS</au><au>Shoo, Anthony, BS</au><au>Teach, Stephen J., MD, MPH</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Primary Care Spatial Density and Nonurgent Emergency Department Utilization: A New Methodology for Evaluating Access to Care</atitle><jtitle>Academic pediatrics</jtitle><addtitle>Acad Pediatr</addtitle><date>2013-05-01</date><risdate>2013</risdate><volume>13</volume><issue>3</issue><spage>278</spage><epage>285</epage><pages>278-285</pages><issn>1876-2859</issn><eissn>1876-2867</eissn><abstract>Abstract Objective To determine the spatial and demographic characteristics of pediatric patients who make nonurgent visits (NUVs) to an urban pediatric emergency department (ED). We hypothesized that the rate of NUVs would be inversely associated with the spatial density of primary care providers (PCPs). Methods A retrospective, cross-sectional analysis was conducted for all visits to Washington, DC’s principal pediatric ED between 2003 and 2006. NUVs were defined by a unique algorithm combining resource allocation, ambulatory-sensitive diagnoses, and billing data. Multivariate linear regression analysis was used to determine the association of PCP density and demographic variables on the spatial rate of NUVs. Results Over the 4-year period, 35.1% (52,110) of the 148,314 ED visits by Washington, DC, residents were nonurgent. NUVs were most associated with neighborhood median household income <$40,000 and low spatial density of PCPs. For every 1-unit increase in PCP density, the spatial rate of NUVs decreased by 9%. The odds of a visit being nonurgent were significantly higher for African Americans and Hispanics than for whites (odds ratio [OR] 2.4, 95% confidence interval [CI] 2.19–2.64; and OR 2.6, 95% CI 2.36–2.86, respectively), for patients using public insurance versus private (OR 1.46, 95% CI 1.42–1.50), and for patients age <5 years (OR 2.66, 95% CI 2.60–2.72). Conclusions Low spatial density of primary care is strongly associated with nonurgent ED utilization. Improving spatial distribution of primary care may decrease ED misuse and improve access to the medical home.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23680346</pmid><doi>10.1016/j.acap.2013.02.006</doi><tpages>8</tpages></addata></record> |
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| subjects | Adolescent Child Child, Preschool Cross-Sectional Studies District of Columbia emergency department use Emergency Service, Hospital - utilization geographic information systems Geography health care delivery/access health disparities Health Services Accessibility - statistics & numerical data Health Services Misuse - statistics & numerical data Healthcare Disparities - statistics & numerical data Humans Infant Linear Models Multivariate Analysis Neonatal and Perinatal Medicine Odds Ratio Pediatrics Physicians, Primary Care - statistics & numerical data Retrospective Studies Urban Population |
| title | Primary Care Spatial Density and Nonurgent Emergency Department Utilization: A New Methodology for Evaluating Access to Care |
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