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. 2010 Nov;164(11):1052-8.
doi: 10.1001/archpediatrics.2010.201.

Missed well-child care visits, low continuity of care, and risk of ambulatory care-sensitive hospitalizations in young children

Jeffrey O Tom  1 , Chien-Wen Tseng, James Davis, Cam Solomon, Chuan Zhou, Rita Mangione-Smith
Affiliations

Missed well-child care visits, low continuity of care, and risk of ambulatory care-sensitive hospitalizations in young children

Jeffrey O Tom et al. Arch Pediatr Adolesc Med. 2010 Nov.

Abstract

Objectives: To determine if adherence to the recommended well-child care (WCC) visit schedule, independent of continuity of care (COC), is associated with lower risk of ambulatory care-sensitive hospitalizations (ACSH) and whether this association varies by chronic disease status.

Design: Population-based, retrospective cohort study.

Setting: Hawaii's largest health plan from 1999 to 2006.

Participants: A total of 36 944 children aged 3.5 years or younger were eligible if they were enrolled prior to 2 months of age, had 4 or more outpatient visits during the study period, and had an enrollment period that overlapped with 1 or more WCC visit interval.

Main exposure: Patients' WCC visit adherence and COC index.

Main outcome measure: Risk of ACSH (hazard ratio [HR]).

Results: Overall, 8921 (24%) children had 1 or more chronic disease. The proportion of ACSH among healthy children vs those with 1 or more chronic disease were 3% (n = 751) and 7% (n = 645), respectively. For children with chronic disease, those with the lowest WCC visit adherence (0%-25%) had 1.9 times (HR, 1.9; 95% confidence interval [CI], 1.5-2.5) the risk of ACSH compared with those in the highest category (75%-100%). The risk of ACSH for children with chronic disease who fell into the lowest COC category (0-0.25) was 2.4 times (HR, 2.4; 95% CI, 1.7-3.5) higher than for those who fell into the highest category (0.75-1.0).

Conclusions: For children with chronic disease, both low WCC visit adherence and COC are independently associated with an increased risk of ACSH. Providing access to a consistent source of primary care appears to be important to this vulnerable population.

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Figures

Figure 1
Figure 1. Patient Eligibility
aWCC, Well-Child Care bChildren were “eligible for analysis” if they had at least 4 outpatient visits prior to censoring, their enrollment period completely overlapped with at least one of the recommended well-child care visit age intervals, and did not have incomplete claims information
See this image and copyright information in PMC

References

    1. Recommendations for Preventive Pediatric Health Care: Committee on Practice and Ambulatory Medicine. Pediatrics. 2007 Dec;120(6):1376. - PubMed
    1. Selden TM. Compliance With Well-Child Visit Recommendations: Evidence From the Medical Expenditure Panel Survey, 2000–2002. Pediatrics. 2006 Dec;118(6):1766–1778. - PubMed
    1. Gilbert JR, Feldman W, Siegel LS, Mills DA, Dunnett C, Stoddart G. How many well-baby visits are necessary in the first 2 years of life? Can Med Assoc J. 1984 Apr 1;130(7):857–861. - PMC - PubMed
    1. Hakim RB, Bye BV. Effectiveness of Compliance With Pediatric Preventive Care Guidelines Among Medicaid Beneficiaries. Pediatrics. 2001 Jul;108(1):90–97. - PubMed
    1. Hoekelman RA. What constitutes adequate well-baby care? Pediatrics. 1975 Mar;55(3):313–326. - PubMed

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