Extended primary care office hours might help keep kids out of the emergency department

(Press-News.org) Ann Arbor, Mich. — Children had half as many emergency department visits if their primary care office had evening office hours on five or more days a week, according to new research from child health experts at C.S. Mott Children's Hospital and Johns Hopkins University.

The new study was published online this month in The Journal of Pediatrics and will be presented at the AcademyHealth Annual Research Meeting.

"These findings are an important step in understanding where primary care practices and medical home programs can be most effective in making changes to enhance access," says U-M pediatrician Joe Zickafoose, M.D., M.S., formerly a research fellow with the Child Health Evaluation and Research Unit at the University of Michigan C.S. Mott Children's Hospital and now a health researcher with Mathematica Policy Research in Ann Arbor, Mich.

Primary care practices for children around the country are working on ways to make it easier for families to communicate with the practice to get advice and make an appointment. A key goal of these efforts is to help parents avoid the stress and expense of unnecessary emergency department visits, and extending office hours into the evening might be an effective way to do this, says Zickafoose.

Efforts around the country to improve health care for children have increasingly focused on the "medical home" as a model to make primary care practices more accessible, comprehensive, and focused on quality improvement. A central aspect of the medical home approach is to enhance families' options for accessing their child's primary care practice, including 24-hour phone advice, email or patient portal communication, same-day sick visits, and evening and weekend office hours.

The investigators found that many parents did not know whether enhanced access services were available in their child's primary care office. Children whose parents reported that their offices had evening hours most nights of the week had half the number of emergency department visits compared to other children even after adjusting for factors such as health insurance and household income. But, only half of parents knew whether their child's office was open after 5 PM. Recent studies have shown that extended office hours seem to decrease emergency department use and some health care costs in adults, but no large studies have looked at practices for children.

The types of changes practices need to make to enhance access can be costly and time consuming, so information about the most effective changes could help practices decide where to commit their resources, Zickafoose says.

Data used in the study came from a national survey of parents. In the survey, parents were asked about characteristics of their child's primary care practice, including 24-hour phone advice, email or patient portal communication, same-day sick visits, and evening and weekend office hours. They were also asked how many times they needed to take their child to the emergency department in the 12 months prior to the survey.

The investigators looked at the association between parents' reports of the "enhanced access services" and the child's emergency department visits, controlling for other factors that are frequently associated with emergency department use.

In this study, other enhanced access services, such as same-day sick visits, were not associated with the rate of emergency department visits.

"We hope that our study encourages parents and primary care practices to communicate more about when the office is open and when they can call for advice," says Zickafoose, lead author of the study.

### Additional authors: Lisa R. DeCamp, MD, MSPH; Lisa A. Prosser, PhD, MS

Disclosures: None

Citation: Zickafoose JS, DeCamp LR, Prosser LA. Association between Enhanced Access Services in Pediatric Primary Care and Utilization of Emergency Departments: A National Parent Survey. The Journal of Pediatrics. 2013 Jun 4. [Epub ahead of print].

About the Child Health Evaluation and Research Unit (CHEAR): Founded in 1998, U-M's CHEAR Unit is a national leader in the analysis of the American health care system and the organization and financing of care for children. Since its inception, the CHEAR Unit has been awarded over $40 million in research grants from federal, state, and foundation sources. The CHEAR Unit comprises core faculty from the Schools of Medicine, Social Work, Dentistry, Pharmacy, Nursing, Public Health, Business and Law. Multidisciplinary teams provide the structure for research of community, state and national child health policies, practices, and programs. There are more than 30 faculty affiliated with CHEAR.

About C.S. Mott Children's Hospital in the University of Michigan Health System: Since 1903, the University of Michigan has led the way in providing comprehensive, specialized health care for children. From leading-edge heart surgery that's performed in the womb to complete emergency care that's there when you need it, families from all over come to the University of Michigan C.S. Mott Children's Hospital for our pediatric expertise. In 2013, C.S. Mott Children's Hospital was ranked eighth in the nation in Parents Magazine's 10 Best Children's Hospitals ranking. To learn more, go to http://www.mottchildren.org.