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Effect of compliance with health supervision guidelines among US infants on emergency department visits
Rosemarie B Hakim1, Donna S Ronsaville
1Centers for Medicare & Medicaid Services, Baltimore, MD 21244, USA. rhakim@CMS.hhs.gov
Insights
Adhering to early well-child care guidelines significantly reduces emergency department (ED) visits for preventable childhood illnesses. Improving compliance with preventive care is crucial for child health services.
Area of Science:
- Pediatric Health
- Preventive Medicine
- Public Health
Background:
- Limited research exists on the health benefits of adhering to early periodic health supervision schedules.
- Understanding the link between preventive care and emergency department (ED) utilization is essential for optimizing child healthcare.
Purpose of the Study:
- To investigate the association between compliance with well-child visit guidelines and the likelihood of ED use for potentially preventable conditions in US children.
- To analyze the impact of preventive care adherence on ED visits for specific diagnoses and all-cause visits.
Main Methods:
- A historical cohort study utilizing data from the 1988 National Maternal and Infant Health Survey and its 1991 Longitudinal Follow-up study.
- Maternal and primary care physician reports on preventive service use in the first 7 months of life were combined.
- Cox proportional hazards survival regression analyzed the time to the first ED visit, controlling for illness severity and using a preventive care scale.
Main Results:
- Children with incomplete well-child care in the first 6 months showed increased ED visit risks for upper respiratory infections (HR, 2.3), gastroenteritis (HR, 1.8), and asthma (HR, 2.1).
- Overall, incomplete preventive care was associated with a higher risk of all-cause ED visits (HR, 1.6).
Conclusions:
- Compliance with national guidelines for early well-child care demonstrably lowers the risk of ED utilization.
- National strategies should prioritize enhancing compliance with periodic preventive care for young children to improve health outcomes and reduce ED burden.
Background:
There are few studies that demonstrate the health benefit of compliance with early periodic health supervision.
Objective:
To examine the association between emergency department (ED) use and compliance with prevailing guidelines for periodic health supervision for conditions that potentially could be avoided among a national cohort of US children.
Design:
This was a historic cohort study that combined maternal and primary care physician reports of the use of preventive care services for infants during the first 7 months of life from the 1988 National Maternal and Infant Health Survey and its 1991 Longitudinal Follow-up study. A preventive care scale used in Cox proportional hazards survival regression predicted the time to the first ED visit for selected diagnoses and all-cause visits controlling for illness severity.
Results:
Among children with incomplete well-child care in the first 6 months of life, there was an increased risk of having an ED visit for an upper respiratory tract infection (hazard ratio, 2.3; 95% confidence interval, 1.6-3.2), gastroenteritis (hazard ratio, 1.8; 95% confidence interval, 1.0-3.0), asthma (hazard ratio, 2.1; 95% confidence interval, 1.0-4.3), and all-cause ED visits (hazard ratio, 1.6; 95% confidence interval, 1.4-1.98).
Conclusions:
Because of the positive effect compliance with national guidelines for early well-child care has on lowering the risk of experiencing ED use, national efforts to improve the quality of child health services for young children should focus on increasing compliance with periodic preventive care for young children.
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