Previous research suggests access to health insurance and a primary care provider (PCP) in a medical home can reduce emergency department (ED) utilization and hospital days for children with medical complexity (CMC). However, other studies point out that access to health insurance and a medical home does not explain all unnecessary ED utilization.
The CARE Award provided a unique opportunity to understand the reasons behind preventable ED utilization for a population that had access to health insurance and a medical home, and to test quality improvement (QI) interventions to decrease ED visits. Access to care is critical for CMC given the fragile nature of their conditions. The framework for improving access to care that ensured families have access to the right care, at the right time, with the right provider, was developed by understanding why families used the ED and how to help them manage their child when acute illness or an exacerbation occurs.