Disparities in quality of healthcare affect utilization

描述(由申请人提供)：每年有超过2200万名儿童前往急诊科就诊，其中约50%为非紧急情况。非紧急急症室就诊与急症室过度拥挤、医疗系统成本增加以及儿童护理分散有关。ED的使用与缺乏初级保健提供者有关，但90%到ED就诊的儿童都有初级保健提供者。到目前为止，还没有研究评估父母对初级保健的感知质量对随后使用ED服务的影响。当父母决定是寻求初级保健提供者的护理还是到急诊室寻求护理时，了解父母对其子女从初级保健提供者那里得到的护理及其与ED利用的关系的看法至关重要。 这项建议的两个总体目标是：1)使用大型数据库，确定父母感知的护理质量预测后续ED使用的能力；2)使用定性方法，从父母和初级保健提供者的角度进一步确定非紧急ED使用的原因。通过实现这些目标，并开展一系列有组织的职业发展活动，应聘者将成为儿童健康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。他会利用从这些来源所得的资料，向向教育署求诊的非紧急病童的家长及该等儿童的初级护理提供者进行重点访问。这些面试的完成和分析将提高应聘者使用混合方法的技能。父母在决定为子女到教育署寻求照顾时所作的选择得到更好的理解，这将导致制定一项干预措施，并在随后的R01资助下进行测试。

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.