Missed Well-Child Care Visits, Low Continuity of Care, and Risk of Ambulatory Care–Sensitive Hospitalizations in Young Children

Tom, Jeffrey; Tseng, Chien Wen; Davis, James W.; Solomon, Cam; Zhou, Chuan; Mangione-Smith, Rita

doi:10.1001/archpediatrics.2010.201

Cited by 64 publications

(60 citation statements)

References 46 publications

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“…25 Similar to our findings, other general pediatric studies have found provider continuity of care to be a strong predictor for receipt of preventive care services. [45][46][47][48][49][50][51] In contrast to other studies in which special health care needs have been associated with increased adherence, 16,19,20,52 chronically ill premature infants were less likely to be adherent with the preventive health schedule. However, we found an opposite relationship between extreme prematurity and chronic illness with regard to adherence ( Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…16 Partly due to variation in the definition of adherence, reported rates range from 8.7% to 86.6%, with infants having greater adherence than older children. [16][17][18][19][20][21][22][23][24][25][26][27][28] These studies mainly involve claims and surveys, with surveys more likely to reflect increased adherence with care. 29 Children with special health care needs have been reported to have similar or higher rates of adherence compared with those without special needs.…”

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confidence: 99%

“…29 Children with special health care needs have been reported to have similar or higher rates of adherence compared with those without special needs. 16,19 There has been only 1 study, limited to children receiving Medicaid, that compared late preterm to term children and found similar rates of adherence. 18 Data about adherence rates for lower birth weight premature infants are lacking.…”

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confidence: 99%

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Preterm Infant Attendance at Health Supervision Visits

et al. 2015

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OBJECTIVES: To assess the adherence of premature infants with the American Academy of Pediatrics health supervision visit schedule, factors affecting adherence, and the association of adherence with preventive care. METHODS:Retrospective cohort of all infants #35 weeks' gestation, born 2005 to 2009, receiving care at a 30-site primary care network for at least 24 months (n = 1854). Adherence was defined as having a health supervision visit within each expected time period during the first 18 months of life. Logistic regression identified sociodemographic and medical factors associated with nonadherence and risk-adjusted association between nonadherence and outcomes.RESULTS: Only 43% received all expected health supervision visits. Those with Medicaid insurance (adjusted odds ratio [AOR] 0.46, 95% confidence interval [CI] 0.35-0.60), a visit without insurance (AOR 0.46, 95% CI 0.32-0.67), chronic illness (AOR 0.7, 95% CI 0.51-0.97), and black race (AOR 0.7, 95% CI 0.50-0.98) were less adherent, whereas provider continuity of care (AOR 2.89, 95% CI 1.92-4.37) and lower birth weight (AOR 1.67, 95% CI 1.02-2.73) increased adherence. Infants ,100% adherent were less likely to be up to date with immunizations and receive recommended preventive care. In nearly half of missed visit windows, no health supervision visit was scheduled.CONCLUSIONS: Fewer than half of premature infants were fully adherent with the preventive health schedule with associated gaps in health monitoring and immunization delays. These data suggest the importance of health supervision visits and the need to explore scheduling facilitators for those at risk for nonadherence. WHAT'S KNOWN ON THIS SUBJECT:Premature infants are at risk for medical and neurodevelopmental sequelae. Close monitoring is an important role for primary care providers. Premature infants have high use of health care services; however, little is known about the role of health supervision visits. WHAT THIS STUDY ADDS:This study explores the utilization and value of health supervision visits for premature infants. Fewer than half were found to be fully adherent to the health supervision visit schedule, resulting in preventive care gaps and immunization delays.

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Section: Discussionmentioning

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Preterm Infant Attendance at Health Supervision Visits

et al. 2015

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“…Therefore, these hospitalizations have been widely used as indicators of the impact of public policies and the accessibility and quality of basic health services. (1)(2)(3) In the field of child health, hospitalizations for ACSC indicate poor attention in primary care, especially since children are considered a priority due to their susceptibility to illness. (4) The importance of primary care for the prevention of hospitalizations is emphasized in several studies, such as one conducted in the United States, which concluded that children who were attended by ambulatory care teams with preventive actions and early detection of health problems had a significant reduction in hospitalization.…”

Section: Introductionmentioning

confidence: 99%

“…(6) Data on the main causes and the trends of hospitalizations for ACSC contribute to support managers and health professionals, especially nurses, in planning and implementing actions to combat the most frequent diseases that affect this population and that can be treated in PHC, thus preventing unnecessary hospitalizations. (3) An important Brazilian tool that professionals can use to find data on these hospitalizations is the Hospital Information System (SIH-SUS). The SIH-SUS provides reliable data for epidemiological analysis, mainly due to the advantage of covering the entire national territory and all hospitalizations funded by the public health sector.…”

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confidence: 99%

Hospitalizações de crianças por condições evitáveis no Estado do Paraná: causas e tendência

et al. 2017

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Objective: To analyze the trends of hospitalizations for ambulatory care-sensitive conditions, according to the main causes among children under five years old. Method: Ecological time-series study carried out with data from the Hospital Information System of the State of Parana. The analysis was based on hospitalization rates and polynomial regression models according to age and cause. Results: The most frequent causes were pneumonia, gastroenteritis, asthma, kidney and urinary tract infection and nutritional disorders. Hospitalizations for pneumonia, asthma and nutritional deficiencies decreased among children under five and hospitalizations rates for gastroenteritis remained stable. There was an increase in hospitalization rates for kidney and urinary tract infection in all ages. Conclusion: Hospitalization for care-sensitive conditions among children under five years presented an increasing trend only for children under one year old. Hospitalizations for pneumonia, gastroenteritis, asthma and nutritional deficiencies showed a decreasing trend. ResumoObjetivo: Analisar a tendência das hospitalizações por condições sensíveis à atenção primária, segundo principais causas em menores de cinco anos. Métodos: Estudo de séries temporais do tipo ecológico realizado com dados do Sistema de Informação Hospitalar do Estado do Paraná. A análise ocorreu a partir das taxas de hospitalização e de modelos de regressão polinomial segundo idade e causa. Resultados: As causas mais frequentes foram pneumonias, gastrenterites, asma, infeção no rim e trato urinário e deficiências nutricionais. As hospitalizações por pneumonia, asma e deficiências nutricionais em menores de cinco anos reduziram e por gastroenterites mantiveram-se estáveis. Houve aumento nas taxas de hospitalização por infecção no rim e trato urinário em todas as idades. Conclusão: A tendência de hospitalização por condições sensíveis em menores de cinco anos foi crescente apenas para as crianças menores de um ano. As hospitalizações por pneumonias, gastroenterites, asma e deficiências nutricionais apresentaram tendência decrescente.

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Association of Continuity of Care With Outcomes in US Veterans With Inflammatory Bowel Disease

et al. 2020

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Missed Well-Child Care Visits, Low Continuity of Care, and Risk of Ambulatory Care–Sensitive Hospitalizations in Young Children

Abstract: To determine if adherence to the recommended well-child care (WCC) visit schedule, independent of continuity of care (COC), is associated with lower risk of ambulatory care-sensitive hospitalizations (ACSH) and whether this association varies by chronic disease status.

Cited by 64 publications

References 46 publications

Preterm Infant Attendance at Health Supervision Visits

Preterm Infant Attendance at Health Supervision Visits

Hospitalizações de crianças por condições evitáveis no Estado do Paraná: causas e tendência

Association of Continuity of Care With Outcomes in US Veterans With Inflammatory Bowel Disease

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