Abstract Although most children receive emergency care in general emergency departments (EDs), national studies have shown that pediatric readiness is low and that the lack of readiness has consequences for clinical quality and outcomes. Presentation to a highly prepared hospital, one with a high pediatric readiness score, is associated with decreased in-hospital mortality. Presence of a pediatric emergency care coordinator (PECC) is associated with increased readiness, but limited data are available to directly assess the association between PECC status and quality of care for children. Previous work has focused primarily on quality variation among specialty pediatric centers which account for a minority of care provided to pediatric patients and have very different staffing and resources as compared to general EDs. Our long-term goal is to develop systems to improve care for children presenting to general EDs. The goal of this R01 project is to define the hospital-level characteristics associated with quality of care provided to children in general EDs. We will use a slate of recently developed process and outcome quality measures across geographically diverse states with high- quality pediatric data available. Our primary hypothesis is that more intensive pediatric-focused staffing (e.g. more robust PECC implementation) is associated with higher-quality care and better clinical outcomes for children. The specific aims are to (1) Identify PECC implementation factors that are associated with variation in quality of emergency care for children (2) Establish if PECC status is associated with higher quality of care for children treated in general EDs and (3) Determine if disparities in quality of care by race/ethnicity and insurance vary by PECC status. The proposed work builds on our pilot work with the National ED Inventory (NEDI-USA) database, as well as on our team’s strong track record in health services research with large administrative databases and qualitative and implementation expertise. In the proposed work, we fulfill two of the primary goals of the NICHD Strategic Plan: (1) “improving child and adolescent health” and (2) addressing “pervasive disparities…improving approaches in populations that experience specific cultural, social, or access issues.” These data will provide a critical understanding of the association between PECC, workforce factors, and quality of care for children. This understanding is the prerequisite for developing evidence-based interventions to improve outcomes for all children receiving emergency care in general EDs.

Project Narrative The proposed work is relevant to public health and to the mission of the NICHD to improve child and adolescent health, and reduce disparities in care. Although most children receive emergency care in general emergency departments (EDs), national studies have shown that pediatric preparedness is low. Presence of a pediatric emergency care coordinator (PECC) is associated with increased preparedness, but limited data are available to assess the association between PECC status, quality of care and outcomes for children. This work will address this knowledge gap to identify actionable strategies to improve care for children receiving care in general EDs.