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Background: Children (ED) and inpatient utilization. Co-location of a primary care clinic within a Head Start center (HSC) includes nursing surveillance of classrooms and same-day primary care access, which allows students at the HSC to be seen immediately for acute care during the day. Consequently, co-location of primary care within a HSC may reduce barriers to acute care for those students, thereby lowering their ED and inpatient utilization.

Objective: To compare ED and inpatient utilization of students from a HSC with co-located primary care to patients treated at an academic primary care clinic (APCC).

Design/Methods: In this retrospective cross-sectional study, we compared ED and inpatient utilization from July 1, 2016 to June 30, 2019 for 278 children from a HSC with co-located primary care to a propensity score-matched comparison group of 810 patients receiving primary care at an APCC located 1.7 miles away. The main outcome was ED and inpatient utilization. ED utilization rate was dichotomized as <1/year and ≥1 visit/year. Inpatient utilization was dichotomized as 0 and ≥1 hospitalization during the study period. The main exposure was being a student at the HSC. A 3:1 comparison group was chosen using propensity score matching based on age, gender, race/ethnicity, language, and insurance type, with a strict match based on home census tract (i.e., every comparison patient lived in the same census tract as the matched HSC student). We used the X2test for bivariate analyses and logistic regression in our multivariable analyses.

Results: HSC and APCC patients had similar demographic characteristics (Table 1). A lower percentage of HSC students had an average of ≥1 ED visits/year than the comparison group (53.6% vs. 64.6%, p=0.001) (Table 2). There were no differences in hospitalizations. In comparison to having ≥1 ED visit/year, HSC students had 55% higher adjusted odds of having /year compared to the APCC group (aOR 1.55 [95% CI: 1.17, 2.06] p=0.002). There continued to be no differences in hospitalizations in our adjusted analyses (aOR 1.12 [95% CI: 0.73, 1.72] p=0.59).

Conclusion(s): Students from a HSC with co-located primary care had lower odds of having ≥1 ED visit/year compared to matched controls from an APCC. Future research should investigate cost differences, other health and developmental outcomes, and comparisons to private primary care practices.

Presented at the 2021 PAS Virtual Conference



Differences in ED and Inpatient Utilization by Location of Primary Care: Co-location at a Head Start Center vs. Academic Primary Care Clinic Setting

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