423 - Access to Care As Predictors of ED Utilization: A Cross-Sectional National Study

Publication Number: 4414.423

Catherine Coughlin, Boston Children's Hospital, Boston, MA, United States; Michael Monuteaux, Boston Children's Hospital, Boston, MA, United States; Rebekah Mannix, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States

Background: The interplay of sociodemographic factors and access to healthcare is complex and multifaceted, and how these factors interact to affect emergency department (ED) utilization is poorly understood. Prior work has demonstrated that differential access to care affects ED utilization.

Objective: To utilize the National Survey on Children's Health (NSCH) for 2023 to examine the association between caregiver-reported access to care and children's ED utilization.

Design/Methods: This was a retrospective, cross-sectional study using the NSCH database. Access to care questions included: (1) caregiver-reported frustration in getting services for the child, (2) having a medical home, and (3) receiving family centered care. The primary outcome was number of ED visits. We estimated multivariable negative binomial regression models for each access to care question as the exposure, adjusted for the following patient characteristics: age, race and ethnicity, sex, insurance type, poverty level, language spoken in the home, and presence of special healthcare needs.

Results: The study included 55,162 participants representative of 72,177,968 children (Table 1). Decreased ED visits were seen among those of younger ages and of Asian race compared to White children in all models. Increased ED visits were seen among American Indian or Alaska Native, Black, non-Hispanic, and Hispanic children compared to White children in all models. Those with public insurance compared to private insurance, with lower family income, and presence of special healthcare needs had increased ED visits in all models. (Table 2). Compared to those never frustrated in getting services, caregivers that were sometimes frustrated and usually/always frustrated had a 45% (95%CI 33%-59%) and 72% (95%CI 46%-101%) increase in the number of ED visits, respectively. Those without a medical home had a 31% (95%CI 20%-43%) increase in the number of ED visits compared to those with a medical home. Those not receiving family centered care had a 23% (95%CI 9%-39%) increase in the number of ED visits compared to those with family centered care.

Conclusion(s): Caregiver-reported access to care factors including frustration in getting services, having a medical home, and family centered care are associated with increased number of ED visits among children; differences by demographic factors were also detected. Family and caregiver experience with care access may serve as a target for interventions to reduce ED utilization.

Table 1. Demographic characteristics of children from the National Survey on Children's Health, 2023


Table 2. Association between emergency department utilization (number of annual ED visits) and access to care factors, adjusted for demographic characteristics, 2023


Table 2. Association between emergency department utilization (number of annual ED visits) and access to care factors, adjusted for demographic characteristics, 2023