In earlier studies we have documented a 35% ER use by infants born at an urban university hospital in the first 3 months of life. The purpose of this study was to evaluate the use of ER's in the first 3 months of life for healthy term infants in the Medicaid population, and to track trends over time with changing health care management. The data for the study was a linked birth certificate (BC) Medicaid claims (MC) data set from the state of Ohio Medicaid Bureau for a single county region for the period from July 92 to June 95. Inclusion criteria: Healthy term infants who had a MC for their inpatient care at the hospital of birth. Methods: Maternal, infant and system variables identified from the BC and MC data. Use of an emergency room within 91 days of birth was the primary outcome variable. Analysis done using univariate (Chi square, trend, t-test), and multivariate (logistic, Cox regression). Results: There were 6,626 infants in the eligible group. 19% of the infants had an ER visit within 91 days. 12% of the infants were delivered by C-section, 36% of the mothers had <2 prenatal visits, mean LOS was 1.85 days, 24.2% had a home and/or primary care visit within<14 days after birth, 46% were white. The proportion of infants with ER visits remained unchanged over the duration of the study (p=0.97). From the univariate analysis, the significant factors associated with ER use included pattern of primary care visits, maternal age, gestation, and prenatal care use. On multivariate analysis, the factors significantly associated with ER use included maternal age (OR=0.96, CI=0.95,0.98), parity (OR=0.92, CI=0.87, 0.98), primary care visit in the first 14 days of life (OR=2.15, CI=1.71, 2.71), primary care visit prior to ER visit (RR=0.49, CI=0.42, 0.58), gestation (OR=0.93, CI=0.88, 0.97), and LOS (OR=.91, CI=0.83, 1.00). Within this population, maternal race and home visits were not significant factors for ER use. In spite of increasing use of home visits, PC visits, and prenatal care by Medicaid enrollees over the duration studied there was no significant difference in the proportion of patients that used the ER in the first 3 months of life suggesting that managed care and other health systems redesign have not impacted this particular pattern of resource use.
