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J Pediatr. 2018 Mar;194:218-224. doi: 10.1016/j.jpeds.2017.10.038. Epub 2017 Dec 1.

Hospitalizations for Ambulatory Care-Sensitive Conditions among Children with Chronic and Complex Diseases.

Author information

1
Department of Pediatrics, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI. Electronic address: rcoller@pediatrics.wisc.edu.
2
Department of Pediatrics, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI; Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, WI.
3
Department of Pediatrics, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI.
4
Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA; RAND Health, RAND Corporation, Santa Monica, CA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA; Children's Discovery and Innovation Institute, UCLA Mattel Children's Hospital, Los Angeles, CA.

Abstract

OBJECTIVE:

To evaluate ambulatory-care sensitive (ACS) hospitalizations for children with noncomplex chronic diseases (NC-CD) and children with medical complexity (CMC), and identify associations with ambulatory care characteristics. Although ACS hospitalizations are potentially preventable in general populations, the specific ambulatory care predictors and influence of medical complexity on them is poorly understood.

STUDY DESIGN:

Retrospective cohort study of NC-CD and CMC hospitalizations at a children's hospital during 2007-2014, excluding labor/delivery and children over 21 years. Pediatric medical complexity algorithm identified NC-CD or CMC. ACS hospitalizations were identified using Agency for Healthcare Research and Quality indicator definitions. Demographic and ambulatory care characteristics were compared between ACS and non-ACS hospitalizations with logistic regression clustered by patient. Measures of ambulatory care during 2 years before admission were explored with 20% random sample of general pediatrics discharges.

RESULTS:

Among 4035 children with NC-CD, 14.6% of 4926 hospitalizations were ACS hospitalizations. Among 5084 CMC, 5.3% of 14 390 discharges were ACS hospitalizations. Among NC-CD discharges, ACS hospitalizations were more likely with no prior-year outpatient visits (OR 1.4, 95% CI 1.1-1.7) and less likely with timely well checks (OR 0.8, 95% CI 0.6-0.9) and phone encounters in the month before admission (OR 0.5, 95% CI 0.2-1.0). Among CMC discharges, the only association observed was with provider continuity (OR 0.3, 95% CI 0.1- 1.0).

CONCLUSIONS:

Provider continuity may be associated with fewer CMC ACS hospitalizations, however, measures of ambulatory care were more consistently associated with ACS hospitalizations for NC-CD. CMC may need more precise ACS hospitalization definitions.

KEYWORDS:

ambulatory care-sensitive conditions; chronic conditions; medical complexity; preventable hospitalizations

PMID:
29198530
PMCID:
PMC5826824
DOI:
10.1016/j.jpeds.2017.10.038
[Indexed for MEDLINE]
Free PMC Article

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