Access to Care as Predictors of Emergency Department Utilization: A Cross-Sectional National Study.

OBJECTIVE: To examine the association between caregiver-reported access to care and children's emergency department (ED) utilization using the 2023 National Survey of Children's Health (NSCH). METHODS: We conducted a cross-sectional study using the 2023 NSCH. Access-to-care measures included having a personal doctor or nurse, a usual place for sick care, difficulty seeing specialists, caregiver frustration obtaining services, presence of a medical home, receipt of family-centered care, effective care coordination, and care in a well-functioning system. The primary outcome was number of ED visits in 1 year. Multivariable Poisson regression models were estimated for each access measure, adjusted for child age, race and ethnicity, sex, insurance type, poverty level, household language, and presence of special health care needs. RESULTS: The sample included 55,162 participants representing 72 million US children. ED visits were higher among American Indian or Alaska Native; Black, non-Hispanic; and Hispanic children compared with White children, and among those with public insurance, lower income, or special health care needs. Among access-to-care measures, the strongest associations were seen for unmet care-coordination needs: children requiring care coordination had roughly double the rate of ED visits compared with those who did not. Increased ED use was also associated with caregiver frustration obtaining services, lack of a medical home, and fragmented systems of care. CONCLUSIONS: Caregiver-reported barriers to coordinated, family-centered care are strongly associated with higher pediatric ED utilization.