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Recommendations for an urban pediatric primary care center to reduce non-urgent emergency department utilization

Kwok, Florence (2019) Recommendations for an urban pediatric primary care center to reduce non-urgent emergency department utilization. Master Essay, University of Pittsburgh.

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Background: In the US, many emergency department (ED) visits are non-urgent. Use of the ED for non-urgent conditions may weaken patient-primary care provider relationships. In 18 months, patients of the UPMC Children’s Hospital of Pittsburgh Primary Care Center of Oakland (CHP PCC) visited the ED 30% (N=135 visits) more, on average, than the CHP PCC for non-preventative outpatient visits. We aim to provide recommendations to the CHP PCC to reduce CHP PCC patients’ non-urgent ED visits.
Methods: We conducted a systematic literature review of national pediatric ED utilization interventions published from 2008-2018. From the results, we identified targeted barriers to primary care and effective interventions. We then conducted a phone survey from December 2017–July 2018, and identified CHP PCC patients aged 1-5 years who presented at either the CHP PCC or the ED with acute respiratory infections. We called patients’ caregivers 1-4 weeks after their visit and assessed their reasons for the index visit. We then compared the PCC group versus the ED group to identify barriers to care at the CHP PCC. We finally formulated recommendations to decrease ED utilization to the CHP PCC.
Results: In the literature review, 10 articles met inclusion criteria. Two barriers were identified; of the 10 studies, 6 targeted health literacy and 4 targeted access. Effective interventions targeting health literacy and access involved community engagement. Three barriers were identified in the CHP PCC survey: health literacy, access, and perceived quality of care. Responders tended to perceive their child’s acute illness as severe. Responders reported low perceived access in terms of availability/accommodation and affordability, and reported high perceived quality of care in terms of acceptability at the CHP PCC. To address barriers, recommendations to the CHP PCC included outreach to high ED-risk populations, improving scheduling, extending hours, and increasing staff and resources.
Public Health Significance: Use of the ED negatively impacts the continuity of care with primary care centers, which is essential for preventative health. Developing tailored, effective interventions to reduce ED visits may improve continuity and ultimately improve child health, with implications for decreasing costs and burden to the ED.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Kwok, Florencefmk10@pitt.edufmk10
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairBertolet, Marniebertoletm@edc.pitt.edubertoletmUNSPECIFIED
Committee MemberRay, Kristinkristin.ray@chp.eduknr16UNSPECIFIED
Committee MemberColvin, Aliciacolvina@edc.pitt.educolvinaUNSPECIFIED
Date: 10 May 2019
Date Type: Submission
Number of Pages: 87
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 15 Oct 2019 16:08
Last Modified: 15 Oct 2019 16:08


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