Related Experiment Videos
Primary care involvement among hospitalized children
J M Perrin1, P Greenspan, S R Bloom
1Children's Service, Massachusetts General Hospital, Boston, USA.
Insights
The child's primary care source significantly impacts prehospital and hospital care, with involvement varying by location and type of practice. Pediatric primary care physician involvement differs across cities and care settings.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Primary Care Medicine
Background:
- The source of primary care for children is crucial for continuity of care.
- Understanding the involvement of primary care physicians (PCPs) before and during hospitalization is essential for improving pediatric healthcare outcomes.
Purpose of the Study:
- To investigate the relationship between the characteristics of a child's usual primary care source and its involvement in care before and during hospitalization.
- To identify variations in PCP involvement based on geographic location and type of healthcare setting.
Main Methods:
- A retrospective medical record review of 1875 pediatric hospitalizations across five diagnostic groups.
- Data collection from hospitals in Boston, New Haven, and Rochester, NY, for children aged 1 month to 12 years.
- Analysis focused on whether the PCP examined the child pre-admission, referred to the emergency department, or provided in-hospital care.
Main Results:
- Primary care sources were identified in 85.7% of reviewed charts.
- Children in Rochester showed higher rates of pre-admission visits, referrals, and in-hospital care by their PCP compared to those in Boston and New Haven.
- PCP involvement varied significantly by city and type of care source (e.g., health centers, private practices, hospitals), with lower involvement generally observed in Boston and New Haven compared to Rochester.
Conclusions:
- The source of primary pediatric care is demonstrably associated with patterns of prehospital and hospital care.
- Specific associations between primary care source and involvement in care are influenced by geographic location.
- Findings highlight the need to consider the role of primary care in pediatric hospital care and potential disparities in involvement.
Objective:
To examine relations between characteristics of a child's usual source of primary care and involvement of that source before and during hospitalization.
Design:
Medical record review of pediatric hospitalizations.
Setting:
All hospitals in Boston, Mass; New Haven, Conn; and Rochester, NY admitting children during the calendar years 1988 through 1990.
Patients:
The study included 1875 randomly selected pediatric hospitalizations for five diagnostic groups (i.e., asthma and other lower respiratory tract disease, abdominal pain [including appendicitis], meningitis [bacterial and viral], toxic ingestions, and head injury). Hospital records selected were limited to children aged between 1 month and 12 years and residing in the three study communities.
Outcome Measures:
Whether the primary care source examined the child before admission to the hospital, referred the child to the emergency department, or served as the in-hospital attending physician.
Results:
Of the medical charts reviewed, 85.7% identified primary care sources. Children in Rochester had higher rates of medical visits before admission (P < .04), referrals (P < .001), and in-hospital care provided by the primary care physician (P < .001, chi 2) than children in Boston and New Haven. Patterns of primary care involvement also varied by source of care within cities, after controlling for income and severity of illness. Compared with children from Rochester community-based private practices, children in Boston receiving care from health centers, hospitals, or community-based private practices generally had 25% to 50% lower likelihood of positive findings on all primary care involvement measures. Children in New Haven receiving care from community-based private or hospital-based practices also had lower rates, but involvement rates were not higher when they received care from health centers. Other children in Rochester and children receiving care from health maintenance organizations in all cities demonstrated almost no significant differences compared with data from Rochester community practices.
Conclusion:
The source of primary care is associated with patterns of prehospital and hospital care among hospitalized children, although specific associations vary by city.