Spokane Journal of Business

Extended pediatric office hours said to trim ER visits

Around-the-clock phone advice, other options curb hospital trips, study says

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Children had half as many emergency department visits if their primary care office had evening office hours on five or more days a week, says new research from child health experts at the University of Michigan's C.S. Mott Children's Hospital, in Ann Arbor, and Johns Hopkins University, of Baltimore.

The new study was published online last month inThe Journal of Pediatrics,and its findings were to be presented at the AcademyHealth Annual Research Meeting late last month.

"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," asserts University of Michigan pediatrician Joe Zickafoose, lead author of the study. Formerly a research fellow with the child health evaluation and research unit at the Mott Children's Hospital, Zickafoose is now a health researcher with Mathematica Policy Research, in Ann Arbor.

Primary-care practices for children around the country are said to be 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 those 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, Zickafoose says.

Such efforts increasingly have 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 didn't 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 with 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 p.m.

Other 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 also were 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 frequently are 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.

C.S. Mott Children's Hospital, part of the University of Michigan Health System, works to provide comprehensive, specialized health care for children. Earlier this year, the hospital appeared eighth in the nation in Parents Magazine's 10 Best Children's Hospitals ranking.

Founded in 1998, Michigan's child health evaluation and research unit works in the analysis of the American health care system and the organization and financing of care for children. Since its inception, the unit has been awarded more than $40 million in research grants from federal, state, and foundation sources.

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