Related Experiment Video
Updated: Jun 23, 2025
Using Continuous Data Tracking Technology to Study Exercise Adherence in Pulmonary Rehabilitation
Published on: November 8, 2013
Adherence with post-hospitalization follow-up after pediatric critical illness due to respiratory failure
Lauren M Yagiela1,2, Marie A Pfarr3, Kathleen Meert4,5
1Division of Critical Care, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA. yagie1lm@cmich.edu.
Insights
Only two-thirds of children with respiratory failure fully adhered to pediatric intensive care unit (PICU) follow-up appointments. Scheduling more appointments before discharge improved adherence, suggesting system-level changes are needed.
Area of Science:
- Pediatric critical care medicine
- Health services research
Background:
- Pediatric intensive care unit (PICU) follow-up is crucial for managing post-discharge sequelae.
- Limited research exists on PICU follow-up adherence rates and influencing factors.
Purpose of the Study:
- Identify factors associated with adherence to recommended follow-up appointments after PICU admission for respiratory failure.
- Analyze hospitalization characteristics, child health metrics, and follow-up specifics.
Main Methods:
- Retrospective cohort study of patients ≤18 years admitted to a quaternary care PICU for respiratory failure (2013-2014).
- Quantified adherence to recommended follow-up appointments within two years post-discharge.
- Compared adherence based on demographics, health metrics, and follow-up characteristics using bivariate and multivariate analyses.
Main Results:
- Of 140 patients with recommended follow-up, 67.9% were fully adherent.
- Each additional recommended appointment decreased adherence odds (OR 0.74).
- Each 10% increase in pre-discharge scheduled appointments increased adherence odds (OR 1.02).
Conclusions:
- Two-thirds of children with respiratory failure achieved full PICU follow-up adherence.
- Strategies to improve adherence include limiting essential follow-ups and scheduling appointments before discharge.
- Further research is needed to understand non-adherence factors for system-level improvements.
Background:
Adherence with follow-up appointments after a pediatric intensive care unit (PICU) admission is likely a key component in managing post-PICU sequalae. However, prior work on PICU follow-up adherence is limited. The objective of this study is to identify hospitalization characteristics, discharge child health metrics, and follow-up characteristics associated with full adherence with recommended follow-up at a quaternary care center after a PICU admission due to respiratory failure.
Methods:
We conducted a retrospective cohort study of patients ≤ 18 years with respiratory failure admitted between 1/2013-12/2014 to a quaternary care PICU. Post-hospitalization full adherence with recommended follow-up in the two years post discharge (1/2013-3/2017) at the quaternary care center was quantified and compared by demographics, baseline child health metrics, hospitalization characteristics, discharge child health metrics, and follow-up characteristics in bivariate and multivariate analyses. Patients were dichotomized into being non-adherent with follow-up (patients who attended less than 100% of recommended appointments at the quaternary care center) and fully adherent (patients who attended 100% of recommended appointments at the quaternary care center).
Results:
Of 155 patients alive at hospital discharge, 140 (90.3%) were recommended to follow-up at the quaternary care center. Of the 140 patients with recommended follow-up at the quaternary care center, 32.1% were non-adherent with follow-up and 67.9% were fully adherent. In a multivariable logistic regression model, each additional recommended unique follow-up appointment was associated with lower odds of being fully adherent with follow-up (OR 0.74, 95% CI 0.60-0.91, p = 0.005), and each 10% increase in the proportion of appointments scheduled before discharge was associated with higher odds of being fully adherent with follow-up (OR 1.02, 95% CI 1.01-1.03, p = 0.004).
Conclusions:
After admission for acute respiratory failure, only two-thirds of children were fully adherent with recommended follow-up at a quaternary care center. Our findings suggest that limiting the recommended follow-up to only key essential healthcare providers and working to schedule as many appointments as possible before discharge could improve follow-up adherence. However, a better understanding of the factors that lead to non-adherence with follow-up appointments is needed to inform broader system-level approaches could help improve PICU follow-up adherence.
Related Concept Videos
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include:
01:30Acute Respiratory Failure-III
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:23Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like...