(SDAS) Preventive Health Services and ED Utilization Among At-Risk Infants
Grantee: Cincinnati Childrens Hospital Med Ctr
Principal Investigator: Neera Goyal
Project Number: R40MC29447
Project Date: 04/01/2016
Age group(s)
- Prenatal
- Perinatal/Infancy (0-12 months)
Targeted/Underserved Population
- African American
Abstract
For low-income children, frequent use of the emergency department (ED) is a key indicator of uncoordinated health care and occurs with significant socioeconomic disparity. Infants less than 1 year of age are particularly vulnerable, with a two-fold higher ED visit rate than older children. Late preterm infants (34-36 weeks gestation) are at even greater risk for frequent ED use, and have been identified as a priority to enhance follow-up support and parental education. We propose to evaluate the relationship between ED use and patterns of engagement across two preventive health service systems: primary care and early childhood home visiting. Currently, these systems operate in parallel, with data infrastructures that are siloed and independent. Little is known of how low-income families with young infants engage across these services over time. Our study sample will be a retrospective, regional cohort of approximately 8,000 late preterm and full term infants in southwest Ohio, served by the Cincinnati Children's Hospital Medical Center (CCHMC) multi-site primary care network. With a total patient population of roughly 32,000 children, this is the largest system of primary care for publically insured children in the region. Infants included in the study will be those born January 2010 - December 2014 at = 34 weeks gestation and registered as a newborn in the CCHMC primary care system. We estimate that within this cohort, approximately 15% meeting high-risk criteria will be enrolled in a regional, multi-site home visiting program either prenatally or during early infancy. Over the first year of life, we will derive multiple measures of engagement in these two systems, i.e. number of routine well child care visits, enrollment and referral status into home visiting. We will use these measures to identify patterns of overall preventive care engagement with advanced statistical modeling (latent class analysis). Analyses will be stratified by gestational age to examine differences by late preterm birth status. Next, we will investigate maternal and infant characteristics associated with differential patterns of engagement. Finally, we will test whether these patterns are associated with ED visit frequency in the first year of life. Data from Ohio vital statistics, electronic health records, and community program records will be linked through a robust bioinformatics organizational structure at CCHMC. Given 2 million ED visits annually for infants on Medicaid, as well as substantial federal investments to expand primary care access, care coordination, and community-based supports, study results have the potential for significant public health impact, informing the development of more effective, targeted efforts to optimize patient experience and health care value. This project aligns with MCHB Strategic Research Issue 2 (MCH services and systems of care to eliminate health disparities) and 4 (promoting healthy development of MCH populations), by studying engagement of low-income families with prevention strategies across clinical and community settings.Publications
Listed is descending order by year published.
Goyal NK, Folger AT, Sucharew HJ, Brown CM, Hall ES, Van Ginkel JB, Ammerman RT. Primary Care and Home Visiting Utilization Patterns among At-Risk Infants. J Pediatr. 2018 May 3. pii: S0022-3476(18)30344-5.
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