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Parental perceptions of avoidability of their child's emergency department visit
  1. Astha Singhal1,2,
  2. Daniel J Caplan1,
  3. Michael P Jones3,
  4. Raymond A Kuthy1,2,
  5. Elizabeth T Momany2,
  6. Christopher T Buresh4,
  7. Peter C Damiano1,2
  1. 1Department of Preventive and Community Dentistry, College of Dentistry, University of Iowa, Iowa City, Iowa, USA
  2. 2Public Policy Center, University of Iowa, Iowa City, Iowa, USA
  3. 3Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, USA
  4. 4Department of Emergency Medicine, College of Medicine, University of Iowa, Iowa City, Iowa, USA
  1. Correspondence to Dr Astha Singhal, Assistant Professor, Health Policy and Health Services Research, Boston University School of Dental Medicine, 560 Harrison Avenue, Boston, MA 02118, USA; asthasinghal{at}


Objectives To identify the factors associated with paediatric emergency department (ED) visits and parental perceptions of the avoidability of their child's ED visit.

Design Cross-sectional study by performing secondary analysis of 2010–2011 Iowa Child and Family Household Health Survey data.

Setting State-wide representative population-based sample of families with at least one child in the state of Iowa in the USA.

Patients/participants Among the eligible households, 2386 families completed the survey, yielding a cooperation rate of 80%.

Exposure/intervention Presence of a medical home.

Main outcome measures Child visiting an ED in the past year; parents believing that ED care could have been provided in a primary-care setting.

Results Among children who needed medical care in the past year, 26% visited an ED. Younger children, non-Hispanic black children, non-Hispanic others, children whose parents were not married, children who were from food-insecure households and had poorer health status were more likely to visit an ED. Having a medical home was not associated with ED visits (OR=0.80, 95% CI 0.61 to 1.04), even after stratifying by the child's health status. About 69% of parents who took their child to an ED agreed that ED care could have been provided in a primary-care setting. Parents of children with public insurance, those who were not referred to the ED and those who could not get routine care appointments were more likely to report a primary-care preventable ED visit.

Conclusions The majority of parents believed that paediatric ED visits could be avoided if adequate primary-care alternatives were available. Expanding access to primary care could lead to a reduction in avoidable ED visits by children.

  • primary care
  • emergency care systems, admission avoidance
  • paediatrics, paediatric emergency medicine

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