Decreasing Nonurgent Emergency Department Utilization by Medicaid Children

Abstract

Objective. To test interventions to decrease the utilization of hospital emergency departments (EDs) for routine, nonemergent health care among Medicaid recipients. Methods. Families of a Medicaid-recipient child presenting to a children's hospital ED for nonurgent problems received information from either a health professional or a clerical employee about the importance of a primary care provider and assistance with making an appointment to the provider of their choice. The health professional continued to work with her assigned families in eliminating barriers to appropriate utilization of a primary care provider for up to 3 months after the index ED visit. A third (comparison) group received no intervention. Subsequent health care utilization for each enrollee was tracked via Ohio Medicaid claims data throughout the four subsequent 6-month periods after the index ED visit. Results. Children in the intervention groups had 11.1% and 14.5% fewer nonurgent ED visits in the 6 months after the index ED visit with a concomitant decrease in cost for this type of care when compared with the comparison group during the same time period. No difference in the number of preventive or ill-child primary care visits was seen. There was no difference in health care cost or utilization in the time period 6 to 24 months after the intervention. Conclusions. Interventions in pediatric EDs aimed at decreasing subsequent ED utilization for nonurgent care can be effective, resulting in modest decreases in the cost of health care for a Medicaid population.