Emergency department utilization in a large pediatric group practice

UMMS Affiliation

Department of Family Medicine and Community Health

Publication Date


Document Type



Age Factors; Child; Emergency Service, Hospital; Female; *Group Practice; Hospital Bed Capacity, 100 to 299; Humans; Male; Massachusetts; Medicaid; Medical Records; Patient Education as Topic; *Pediatrics; Severity of Illness Index; Triage; United States


Community Health and Preventive Medicine | Preventive Medicine | Primary Care


The effect of a triage and care system, which employs continued patient education, alternatives to emergency department (ED) care for nonemergent problems, and close cooperation between ED staff and the primary care physician on inappropriate ED use, was analyzed for three groups of patients: (a) Medicaid patients, all of whom had unrestricted access to the ED; (b) group A patients who required prior physician approval and copayments for all ED services; and (c) patients enrolled in group B who were responsible for copayments only and did not require prior physician approval for ED use. Two hundred ninety-nine (299) charts were prospectively reviewed for age, payer status, date, time of visit, diagnosis, outcome of visit, and severity of illness. Medicaid patients utilized the ED much more than expected, compared to either group A or B patients (P < 0.001). Expected rates of utilization were based upon that particular group's representation in a medical associate's patient panel, which was based upon patient billing data. Medicaid patients were significantly younger than group A or B patients (P < 0.001) and had lower severity scores (P = 0.04). Our triage and care system failed to alter patterns of ED utilization for Medicaid patients.


Am J Med Qual. 1995 Summer;10(2):88-92.

Journal/Book/Conference Title

American journal of medical quality : the official journal of the American College of Medical Quality

Related Resources

Link to article in PubMed

PubMed ID