BRIEF RESEARCH REPORT article
Front. Pediatr.
Sec. Social Pediatrics
Volume 13 - 2025 | doi: 10.3389/fped.2025.1614456
This article is part of the Research TopicHealthcare And Child Protection Synergy: Preventing Maltreatment And Promoting WellbeingView all articles
Emergency department utilization among youth in foster care: benefits of a patientcentered medical home
Provisionally accepted
- 1Department of Pediatrics, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, United States
- 2Brown School, Washington University in St. Louis, St. Louis, Missouri, United States
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Background: Foster youth face unique medical, psychological, and social challenges, which can impact patterns of emergency department (ED) utilization. The patient-centered medical home (PCMH) offers a potential model to reduce overutilization of healthcare resources. Little work has examined relationships between PCMHs and ED utilization among foster youth.We sought to describe longitudinal trends in ED utilization among foster youth in a PCMH. Methods: This retrospective cohort study leveraged electronic health record data from foster youth seen in a PCMH from 2018-2024. Frequency of ED utilization was calculated before, during, and after involvement in the PCMH. We used Poisson generalized linear mixed models to examine associations between each time period (before, during, or after) and the frequency of ED visits, adjusting for age, sex, and race/ethnicity. Results are presented as incidence rate ratios (IRR) with 95% confidence intervals (95% CI). Results: Out of 857 youth, 525 (61.3%) were female. Median age was 15.5 years (IQR: 14.2-16.8). Most youth were Black or African American (n=643; 75.0%). The median number of ED visits was three (IQR: 2-7) for the total observation period. Compared to before the PCMH, ED utilization was significantly lower during engagement with the PCMH (IRR: 0.62 [95% CI: 0.54-0.70]). ED utilization increased after the last PCMH encounter (IRR: 1.12 [95% CI: 1.01-1.24]). Conclusions: Engagement in a PCMH was associated with lower ED utilization among foster youth. Findings suggest that PCMHs may decrease healthcare costs and better support foster youths' specific health needs.
Keywords: Foster youth, Health Services, Emergency department (ED) utilization, Patient centered medical home, Trauma informed care
Received: 18 Apr 2025; Accepted: 14 Aug 2025.
Copyright: © 2025 Szoko, Phad, Fournier, Hoganson and Jonson-Reid. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Nicholas Szoko, Department of Pediatrics, School of Medicine, Washington University in St. Louis, St. Louis, 63110, Missouri, United States
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