No outside funding was used to support this research. For further information, contact: Victoria L. Wagner, MS, Office of Health Insurance Programs, NYS Department of Health, Empire State Plaza, Room 1938, Albany, NY 12237; e-mail firstname.lastname@example.org.
Emergency Department Reliance Among Rural Children in Medicaid in New York State
Article first published online: 27 APR 2011
© 2011 National Rural Health Association
The Journal of Rural Health
Volume 28, Issue 2, pages 152–161, Spring 2012
How to Cite
Uva, J. L., Wagner, V. L. and Gesten, F. C. (2012), Emergency Department Reliance Among Rural Children in Medicaid in New York State. The Journal of Rural Health, 28: 152–161. doi: 10.1111/j.1748-0361.2011.00377.x
- Issue published online: 28 MAR 2012
- Article first published online: 27 APR 2011
- Access to care;
- emergency department;
- utilization of health services
Abstract Purpose: This study examines variation in emergency department reliance (EDR) between rural and metro pediatric Medicaid patients in New York State for noninjury, nonpoisoning primary diagnoses and seeks to determine the relationship between receipt of preventive care and the likelihood of EDR.
Methods: Rural/urban designations were based on Urban Influence Codes established by the United States Department of Agriculture (USDA). Healthcare Effectiveness Data and Information Set (HEDIS®) well-visit measures were calculated using 2008 Medicaid claims and encounter data. Well-child numerator status and location of residence variables were then entered as independent variables in multivariate logistic regression models. Models controlled for the effects of Medicaid financing system (fee-for-service vs managed care), Medicaid aid type, race/ethnicity, gender, and 2008 clinical risk group category.
Findings: The likelihood of EDR was higher in all age categories for rural compared to metro residing Medicaid children in New York State. Meeting HEDIS well-child criteria was protective against emergency department (ED) reliance in the adolescence age group (OR = 0.84).
Conclusion: ED reliance is associated with rural residence. Increased access to primary and specialty care in rural settings could help reduce EDR, particularly among rural adolescents.