UMMS Affiliation

Commonwealth Medicine, Center for Health Policy and Research

Publication Date

2018-08-10

Document Type

Article

Disciplines

Emergency Medicine | Health Policy | Health Services Administration | Health Services Research | Pediatrics

Abstract

Introduction: This study evaluates the impact of practice participation in a pediatric patient-centered medical home learning collaborative on preventable emergency department (ED) visits among children in MassHealth (Massachusetts Medicaid/Children's Health Insurance Program).

Methods: Claims and enrollment data were extracted for child MassHealth members (aged 3–18) comprising 2 groups: members enrolled in a group of 13 child-serving practices that participated in an intensive, 29-month long patient-centered medical home learning collaborative (intervention group), and members enrolled in a group of 12 comparison practices with roughly similar panel size, type, and geographic location (comparison group). Preventable ED visits were identified using a modified version of the New York University ED algorithm. Two analyses were then conducted: (1) a repeat cross-sectional analysis among children enrolled in intervention or comparison group practices during baseline (first half of 2011) and follow-up (second half of 2013) periods; and (2) a longitudinal analysis among a subset of children enrolled for the full study period (2011–2013). Both analyses tested whether the effect of the intervention differed for children with versus without chronic conditions (effect modification).

Results: Preventable ED visits declined from baseline to follow-up among children in both intervention and comparison practices. In the cross-sectional analysis, the decrease was the same in both practice groups, and for children with versus without chronic conditions. The longitudinal analysis shows a statistically significantly greater decrease among children with chronic conditions enrolled in the intervention practices (P = 0.02).

Conclusion: Children with chronic conditions might receive the greatest benefit from receiving care in a medical home setting.

Keywords

Pediatrics, MassHealth, preventable emergency department visits, medical home

Rights and Permissions

Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

DOI of Published Version

10.1097/pq9.0000000000000097

Source

Kirby PB, Christensen AL, Bannister L, Konar V. Association between Practice Participation in a Pediatric-focused Medical Home Learning Collaborative and Reduction of Preventable Emergency Department Visits by Publicly-insured Children in Massachusetts. Pediatr Qual Saf 2018;3:097. doi: 10.1097/pq9.0000000000000097. Link to article on publisher's website

Journal/Book/Conference Title

Pediatric Quality and Safety

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

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