Associations between quality of primary care and health care use among children with special health care needs

Objective: To determine whether parent-reported quality of primary care was associated with subsequent health care use for children with special health care needs. Design: Secondary analysis of prospectively collected data. Setting: The 2004-2005 and 2005-2006 Medical Expenditure Panel Survey panels. Participants: A total of 1591 children with special health care needs. Main Exposures: Composite measures for family centeredness of care, timeliness of care, and realized access derived from the Consumer Assessment of Healthcare Providers and Systems survey. Main Outcome Measures: Rates of parent-reported emergency department visits (nonurgent and urgent) and hospitalizations. Only encounters occurring after completion of the Consumer Assessment of Healthcare Providers and Systems survey were assessed. Weighted multivariate Poisson regression analyses, yielding incident rate ratios, were used for analysis. Results: Of the parents of the 1591 children included, 68.3% rated family centeredness, 51.5% rated timeliness, and 80.4% rated realized access as high quality. Low-quality family centeredness was associated with higher rates (incident rate ratio, 2.24;95%confidence interval, 1.32-3.80) of nonurgent emergency department visits compared with corresponding rates associated with high-quality family centeredness. There were no associations between quality-of-care domains and rates of urgent emergency department visits. For privately insured children, low-quality family centeredness was associated with higher rates (incident rate ratio, 3.87; 95% confidence interval, 1.23-12.13) of hospitalizations compared with corresponding rates associated with high-quality family-centered care. For publicly insured children, no significant associations were found. Conclusions: Parent-reported, low-quality family centeredness was associated with higher rates of subsequent nonurgent emergency department visits and hospitalizations among children with special health care needs. These findings highlight family-centered care as a critical area for primary care intervention to reduce potentially preventable health care use.