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Outpatient follow-up visits and readmission in medically complex children enrolled in Medicaid
Mark S Brittan1, Marion R Sills1, David Fox1
1Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Children's Outcome Research Program, University of Colorado School of Medicine, Aurora, CO.
Insights
Early outpatient follow-up after hospital discharge increases readmission risk in children with complex conditions. However, later follow-up (4-29 days) is associated with reduced 30-day readmissions, suggesting a critical window for intervention.
Area of Science:
- Pediatric Healthcare Research
- Health Services Research
- Chronic Disease Management
Background:
- Medicaid-enrolled children with complex, chronic conditions face high 30-day hospital readmission rates.
- Understanding the impact of postdischarge outpatient follow-up is crucial for optimizing care transitions and reducing readmissions in this vulnerable population.
Purpose of the Study:
- To investigate the association between postdischarge outpatient follow-up timing and 30-day readmissions.
- To analyze the impact of early (≤ 3 days) versus later (4-29 days) outpatient visits on readmission risk in pediatric patients with complex chronic conditions.
Main Methods:
- Retrospective cohort analysis of Colorado Medicaid recipients with complex, chronic conditions discharged between 2006-2008.
- Multivariable logistic regression used to assess the relationship between outpatient visit timing and 4-30 day readmissions.
- Primary outcome: readmission between 4 and 30 days post-discharge. Secondary analysis: outpatient visits within 4-29 days.
Main Results:
- The 4-30 day readmission rate was 6.3% among 2415 included patients.
- Early outpatient visits (≤ 3 days postdischarge) were associated with a significantly increased odds of readmission (aOR 1.7).
- Later outpatient visits (4-29 days postdischarge) were associated with significantly lower odds of readmission (aOR 0.5).
Conclusions:
- Early postdischarge outpatient follow-up is positively associated with readmission in medically complex children.
- Outpatient follow-up within 4-29 days postdischarge shows an inverse association with 30-day readmissions, potentially preventing them.
- Further research is needed to establish optimal postdischarge follow-up guidelines for this population.
Objective:
To examine the association between postdischarge outpatient follow-up and 30-day readmissions in Medicaid enrolled children with complex, chronic conditions.
Study Design:
This was a retrospective cohort analysis of Colorado Medicaid recipients with complex, chronic conditions who were discharged from the hospital between 2006 and 2008. The primary outcome was readmission between 4 and 30 days after index hospital discharge. Using multivariable logistic regression, we examined the association between early postdischarge outpatient visits (≤ 3 days postdischarge) and readmission. We secondarily analyzed the relationship between any outpatient visit from 4 to 29 days of index discharge and readmission.
Results:
For the 2415 patients with complex, chronic conditions included in the analysis, the 4- to 30-day readmission rate was 6.3%. The odds of readmission was significantly greater for patients with ≥ 1 outpatient visit ≤ 3 days after discharge compared with patients without a visit ≤ 3 days after discharge (aOR 1.7 [1.1-2.4]). The odds of readmission were significantly lower for patients with ≥ 1 outpatient visit from 4 to 29 days after discharge compared with patients without such visits (aOR 0.5 [0.3-0.7]). Other factors associated with readmission included index hospital length of stay and number of complex, chronic conditions.
Conclusions:
In medically complex children, there is a positive association between early postdischarge outpatient follow-up and readmission. There is an inverse association between later postdischarge outpatient follow-up and readmission. Outpatient follow-up occurring within 4-29 days after discharge may help to prevent 30-day readmissions. Additional research is needed to inform guidelines regarding longer term postdischarge outpatient follow-up in these children.
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