Project Summary

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.

What is this research about?

Children usually go through the emergency department, or ED, to be admitted to the hospital. But going through the ED may not be the most efficient way for patients and their families to get care. Wait times in the ED can be long. Also, clinicians in the ED don’t know a child’s health history as well as the child’s primary care doctor.

Another way to admit children to the hospital is direct admission. With direct admission, the child’s primary care or urgent care doctor contacts the hospital to admit the child. Direct admission can improve communication between the child’s doctor and hospital staff. But hospitals need to set up a process for direct admission.

In this study, the research team is comparing how quickly children receive care with direct admission versus admission through EDs. The team also wants to see if direct admission helps some patients more than others or improves families’ experience of care.

Who can this research help?

Results may help hospital administrators when considering ways to improve hospital admissions.

What is the research team doing?

The research team is assigning 3 hospitals and 47 children’s health clinics by chance to start the direct admission process at different times during the study. The team is looking at hospital records for children admitted for infections or other common health problems to see

  • How quickly children get care after arriving at the hospital
  • How often children are admitted to intensive care
  • How often children stay at the hospital for less than one day
  • Families’ experiences with hospital admission

Also, during their child’s hospital stay, parents answer surveys about their experience with hospital admission.

The research team is comparing patients within the same doctors’ offices before and after the offices start the direct admission process.

Families of children admitted to hospitals, doctors, nurses, and hospital staff help with this study.

Research methods at a glance

Design Element Description

Cluster randomized controlled trial

Population 1,696 children up to age 17 from 3 hospitals and 47 children’s health clinics across the United States
  • Direct admission
  • ED admission

Primary: length of time from arrival at the hospital until the start of definitive clinical care

Secondary: rate of transfer to pediatric intensive care, hospital stays <12 or <24 hours, family hospital admission experience

Timeframe 6-hour follow-up for primary outcome 

Engagement Resources

Project Information

JoAnna Leyenaar, MD, MPH, MS
Dartmouth-Hitchcock Clinic^
Comparative Effectiveness of Direct Admission & Admission through Emergency Departments for Children

Key Dates

April 2019
November 2024

Study Registration Information

^This project was originally affiliated with the Trustees of Dartmouth College.


Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: September 26, 2023