Disparities in quality of healthcare affect utilization

描述（由申请人提供）：每年有超过2200万儿童急诊（艾德）就诊，其中约50%是非紧急情况。非紧急艾德就诊与艾德过度拥挤、医疗保健系统成本增加以及儿童护理分散有关。艾德利用与缺乏初级保健提供者有关，但90%的儿童到艾德有初级保健提供者。到目前为止，还没有研究评估的影响，家长感知质量的初级保健对随后的利用艾德服务。当父母决定是从初级保健提供者还是在艾德寻求护理时，关键是要了解父母对他们的孩子从初级保健提供者获得的护理的看法及其与艾德利用的关系。 该提案的两个总体目标是：1）使用大型数据库，以确定父母感知的护理质量预测随后的艾德利用的能力; 2）使用定性方法，从父母和初级保健提供者的角度进一步定义非紧急艾德利用的原因。通过实现这些目标，并开展一系列结构化的职业发展活动，候选人将成为儿童保健服务利用方面的专家。候选人将发展分析复杂调查样本的技能，并将学习分析医疗补助索赔数据。他将利用从这些来源了解到的信息，制定并随后对向艾德提出非紧急情况的儿童的父母和这些儿童的初级保健提供者进行重点访谈。完成和分析这些面试将提高候选人使用混合方法的技能。进一步了解父母在决定为子女到艾德寻求护理时所作的选择，将有助于制定一项干预措施，并在随后的R 01资金中进行测试。

DESCRIPTION (provided by applicant): There are over 22 million emergency department (ED) visits each year by children, and approximately 50% of these visits are for non-urgent conditions. Non-urgent ED visits are associated with overcrowding of the ED, increased cost to the healthcare system, and fragmented care of the child. ED utilization is related to the lack of a primary care provider, but 90% of children presenting to the ED have a primary care provider. To date, there have been no studies evaluating the effect of the parental perceived quality of primary care on subsequent utilization of ED services. As the parent makes the decision whether to seek care from the primary care provider or in the ED, it is critical to understand the parent perspective on the care their child receives from the primary care provider and its relationship to ED utilization. The two overall goals of this proposal are: 1) using large databases, to determine the ability of parental perceived quality of care to predict subsequent ED utilization; and 2) using qualitative methods, to further define the reasons for non-urgent ED utilization from the perspective of both the parent and the primary care provider. By carrying out these goals, and undertaking a structured set of career development activities, the candidate will become an expert in child health services utilization. The candidate will develop skills in analyzing complex survey samples, and will learn to analyze Medicaid claims data. He will use the information learned from these sources to develop and then conduct focused interviews with parents of children who present to the ED with non-urgent conditions and the primary care providers of those children. Completion and analysis of these interviews will enhance the candidate's skills in the use of mixed methods. The improved understanding of the choices parents make when deciding to seek care in the ED for their children will lead to the development of an intervention to be tested with subsequent R01 funding.