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Well-child care visits and risk of ambulatory care-sensitive hospitalizations
Jeffrey O Tom1, Rita Mangione-Smith, David C Grossman
1Kaiser Permanente Center for Health Research, Hawaii, 501 Alakawa St, Ste 201, Honolulu, HI96817. jeffrey.o.tom@kp.org
Insights
Poor adherence to well-child care visits increases hospitalization risk for young children. This study highlights the importance of regular check-ups for preventing Ambulatory Care-Sensitive Hospitalizations (ACSHs).
Area of Science:
- Pediatric Health Outcomes
- Healthcare Delivery Systems
- Preventive Care Research
Background:
- Well-child care (WCC) visits are crucial for monitoring child development and preventing illness.
- Ambulatory Care-Sensitive Hospitalizations (ACSHs) represent hospitalizations for conditions that could potentially be prevented with adequate outpatient care.
Purpose of the Study:
- To investigate the association between suboptimal adherence to WCC visits and the risk of ACSHs in young children.
- To evaluate this association within an integrated healthcare delivery system.
Main Methods:
- A retrospective observational study utilizing claims and administrative data.
- Analysis included 20,065 children aged 2 months to 3.5 years from 1999-2006.
- Cox proportional hazard regression models assessed the link between WCC visit adherence and ACSH risk.
Main Results:
- Children with lower WCC visit adherence (0-25%) faced a 2.0-fold increased hazard for ACSH (P < .001).
- Even moderate non-adherence (26-50%) showed a 1.4-fold increased hazard (P < .05).
- Children with multiple chronic diseases and poor WCC adherence had significantly higher ACSH risks (HRs 1.9-3.2).
Conclusions:
- Poor adherence to well-child care visits is a significant risk factor for Ambulatory Care-Sensitive Hospitalizations in young children.
- Maintaining regular WCC visit schedules is vital for preventing unnecessary hospitalizations in pediatric populations.
- Findings underscore the importance of WCC adherence monitoring within integrated healthcare systems.
Objectives:
To determine if poor well-child care (WCC) visit adherence is associated with increased risk for Ambulatory Care-Sensitive Hospitalizations (ACSHs) among young children in an integrated healthcare delivery system.
Study Design:
This was a retrospective observational study.
Methods:
We used claims and administrative data for children aged 2 months to 3.5 years enrolled at Group Health Cooperative from 1999 to 2006. Our main independent variable was timely WCC visits based on Group Health's 2000 recommended schedule. We used Cox proportional hazard regression models to determine the association between WCC visit adherence and risk for a child's first ACSH.
Results:
Of the 20,065 children, 797 (4%) had an ACSH. Children with lower WCC visit adherence had increased hazard ratios (HRs) of 1.4-2.0 for ACSH (adherence 0-25%: HR 2.0, 95% confidence interval [CI]: 1.6-2.6, P < .001; adherence 26-50%: HR 1.4, 95% CI: 1.1-1.8, P < .05). Of the 2196 children with > 1 chronic disease, 189 (9%) had an ACSH. Children with > 1 chronic disease and with lower WCC visit adherence also had increased HRs for ACSH (adherence 0-25%: HR 3.2, 95% CI: 1.8-5.6, P < .001; adherence 26-50%: HR 1.9, 95% CI: 1.2-3.2, P < .05).
Conclusions:
For young children, poor WCC visit adherence was associated with increased risk for ACSH in this integrated healthcare delivery system.
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