Rates of pediatric health care utilization are commonly used as outcome measures of realized access to care. Although past studies on pediatric health care utilization have conceptualized use of care to be directly influenced by various sociodemographic, financial, and health factors (e.g. age, sex, family structure, insurance status, household income, health status), few studies have examined the effect of parent and family characteristics on children's health care use. Because children depend on their parents/guardians to seek out, consent to, and pay for health care, this addition is theoretically important. Moreover, few studies on children's health care utilization have specifically examined a primarily low-income, minority community population, again reinforcing the need to examine parents' and family's contribution to children's health care utilization. The primary aim of this study is to test, in a low-income minority, nurse-managed primary care clinic site, a theoretical model that has been designed specifically for pediatric health care utilization. This study proposes that specific parent/family factors (e.g. family environment, parenting behavior) affects children's use of health care and that this affect is over and above the effect of children's health status on their health care utilization. Some of the variables, such as the family environment and parenting behavior, hypothesized to affect children's health status and their use of health care, are targets of advanced practice nursing interventions. A prospective cohort design will be used to address the research questions in the study. The results of this pilot study will then be used to modify and refine the theoretical model, which will then be used for future studies. This study will the first of a series of studies examining the impact of nurse-managed clinics on health care utilization rates. The results of these studies has the potential to influence health policy in how care is delivered.
