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Posthospitalization follow-up recommendations after pediatric critical illness due to respiratory failure
Lauren M Yagiela1,2, Marie A Pfarr3, Kathleen L Meert1,2
1Division of Critical Care, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA.
Insights
Pediatric critical illness follow-up varies significantly by provider type and location. This study highlights the need for standardized post-hospitalization care recommendations for children with respiratory failure.
Area of Science:
- Pediatric critical care medicine
- Respiratory medicine
- Health services research
Background:
- Pediatric critical illness, particularly respiratory failure, necessitates careful post-hospitalization follow-up.
- Current follow-up care patterns lack standardization, potentially impacting patient outcomes.
Purpose of the Study:
- To characterize recommended posthospitalization follow-up care for children with respiratory failure.
- To analyze follow-up by provider type (primary vs. specialty care) and location (community vs. tertiary care centers).
Main Methods:
- Retrospective cohort study of children (≤18 years) admitted for respiratory failure.
- Medical chart review to identify post-hospitalization follow-up recommendations.
- Analysis of follow-up patterns, including subgroups receiving extracorporeal membrane oxygenation or tracheostomy.
Main Results:
- Eighty percent of patients were recommended primary care follow-up, but only 52.9% were recommended pulmonology follow-up.
- Ten unique follow-up patterns were identified based on provider type and location.
- Primary care follow-up was more common in community settings (74.2%), while specialty care was more common in tertiary settings (68.6%).
Conclusions:
- Significant variability exists in recommended follow-up care after pediatric respiratory failure.
- Findings underscore the need for improved standardization of post-hospitalization follow-up for critically ill children.
- This variability suggests potential areas for enhancing care coordination and patient outcomes.
Objectives:
To characterize the recommended posthospitalization follow-up by provider type and location after a pediatric critical illness due to respiratory failure.
Working Hypothesis:
After pediatric critical illness due to respiratory failure, patients will not have a standard follow-up pattern with regard to provider type or follow-up location.
Study Design:
A retrospective cohort study.
Subject Selection:
Children, 18 years or younger, admitted to a quaternary care pediatric intensive care unit with respiratory failure between January 1, 2013 and December 31, 2014.
Methodology:
For eligible patients, recommendations for posthospitalization follow-up including provider type (primary care and specialty care) and location (community care center vs. tertiary care center) were characterized from medical chart review. Recommendations were examined for all patients and two patient subgroups (patients who received extracorporeal membrane oxygenation and patients with tracheostomy).
Results:
Of 155 patients alive at hospital discharge, the median age was 2.1 (interquartile range, 0.7-10.6) years. Eighty percent of patients were instructed to follow-up with a primary care provider but only 52.9% with a pulmonologist. We found 10 unique follow-up patterns between provider location (community care center, tertiary care center, or both) and global provider type (primary care versus specialty care). Primary care follow-up was recommended more often at community locations (74.2%), whereas specialty care was more often recommended at tertiary care centers (68.6%).
Conclusions:
Our study findings demonstrate significant variability in the recommendations for follow-up by provider type and location after hospitalization for acute respiratory failure and highlight areas for improvement in follow-up care after pediatric critical illness.
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