Disparities in quality of healthcare affect utilization

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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.