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Hospitalizations for Ambulatory Care-Sensitive Conditions among Children with Chronic and Complex Diseases
Ryan J Coller1, Michelle M Kelly2, Mary L Ehlenbach1
1Department of Pediatrics, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI.
Insights
Ambulatory-care sensitive hospitalizations were more common in children with noncomplex chronic diseases (NC-CD) than those with medical complexity (CMC). For NC-CD, fewer outpatient visits and timely well-child checks reduced these hospitalizations.
Area of Science:
- Pediatric Healthcare Research
- Health Services Research
- Chronic Disease Management
Background:
- Ambulatory-care sensitive (ACS) hospitalizations are potentially preventable events that highlight gaps in outpatient care.
- Understanding predictors of ACS hospitalizations, particularly for children with varying levels of medical complexity, is crucial for improving care coordination and reducing healthcare costs.
- Existing research has not fully elucidated the specific ambulatory care characteristics associated with ACS hospitalizations in pediatric populations, especially when differentiating between noncomplex chronic diseases (NC-CD) and children with medical complexity (CMC).
Purpose of the Study:
- To evaluate the rates of ambulatory-care sensitive (ACS) hospitalizations for children with noncomplex chronic diseases (NC-CD) and children with medical complexity (CMC).
- To identify specific ambulatory care characteristics associated with ACS hospitalizations in these pediatric populations.
- To explore the influence of medical complexity on the relationship between ambulatory care and ACS hospitalizations.
Main Methods:
- A retrospective cohort study was conducted using hospitalization data from 2007-2014 at a children's hospital.
- Children were categorized as NC-CD or CMC using a validated pediatric medical complexity algorithm.
- ACS hospitalizations were identified using Agency for Healthcare Research and Quality (AHRQ) indicators, and logistic regression was used to analyze associations with demographic and ambulatory care characteristics.
Main Results:
- Children with NC-CD experienced ACS hospitalizations at a rate of 14.6%, while those with CMC had a rate of 5.3%.
- For NC-CD, ACS hospitalizations were associated with no prior-year outpatient visits (OR 1.4) and fewer timely well-child checks (OR 0.8).
- Provider continuity was the only significant association found for CMC ACS hospitalizations (OR 0.3).
Conclusions:
- Ambulatory care measures, such as prior outpatient visits and well-child checks, were more consistently associated with ACS hospitalizations in children with NC-CD.
- Provider continuity may play a role in reducing ACS hospitalizations for CMC, but further research is needed.
- Refined definitions of ACS hospitalizations may be necessary for the CMC population to better capture preventable events.
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.
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