Association Between Infant Continuity of Care and Pediatric Emergency Department Utilization

OBJECTIVE: The objective of this study was to examine the association between continuity of care (COC) and emergency department (ED) utilization during infancy, when the bonds between a provider and a family are first forming and health care utilization is at it highest levels. METHODS: A retrospective birth cohort was conducted of children who were born between December 1, 1999, and April 30, 2000; health care use during the first 25 months of life was analyzed. A COC score was calculated from well-child visits in the first 7 months of life. Subsequent ED utilization, for both a 12-month and an 18-month period, was evaluated through 2 measures: 1) ED reliance (the fraction of all visits that occurred in the ED) and 2) number of ED visits. Spearman rank correlation coefficients (r(s)) between COC and ED utilization were calculated. Partial rank correlations were calculated controlling for Medicaid status, income, gender, and the total number of health care visits. RESULTS: A total of 181 children were included in the study; 96 (53%) were male, and 48 (27%) were covered by Medicaid. COC scores ranged from 0 to 1, with a median of 1. COC scores were negatively correlated with both ED reliance (r(s) = -.214) and number of ED visits (r(s) = -.215) with 12 months of follow-up. The negative correlation was even stronger at 18 months of follow-up (ED reliance: r(s) = -.247; number of ED visits: r(s) = -.242), and this relationship remained significant with partial rank correlations. CONCLUSIONS: Improved COC in infancy is associated with a decrease in subsequent ED utilization. Interventions aimed at increasing the continuity of early well-child visits may decrease ED utilization.