Outpatient Follow-Up Visits and Readmission in Medically Complex Children Enrolled in Medicaid

Brittan, Mark; Sills, Marion R.; Fox, David; Campagna, Elizabeth J.; Shmueli, Doron; Feinstein, James A.; Kempe, Allison

doi:10.1016/j.jpeds.2014.12.022

Cited by 32 publications

(36 citation statements)

References 36 publications

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“…12 There are limitations to important contextual details from these data, although they could suggest that outpatient clinic followup outside of the ED, whether urgent or nonurgent, may be associated with less postdischarge utilization. Continuity with pediatric providers has been associated with fewer ED visits, hospitalizations, 31 and potentially preventable hospitalizations, 32 but this question remains largely unexplored for readmissions.…”

Section: Medical Home and Usual Source For Carementioning

confidence: 94%

“…[10][11][12][13] Far less attention has been paid to conceptually important constructs such as overall primary care experience, caregiver activation, and broad social determinants of health. These limitations in readmissions research might explain some of the counterintuitive findings observed thus far 7,14,15 and why tools that predict readmissions with high sensitivity and specificity are not yet available.…”

Section: What This Study Addsmentioning

confidence: 99%

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The Medical Home and Hospital Readmissions

et al. 2015

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BACKGROUND AND OBJECTIVE: Despite considerable attention, little is known about the degree to which primary care medical homes influence early postdischarge utilization. We sought to test the hypothesis that patients with medical homes are less likely to have early postdischarge hospital or emergency department (ED) encounters.METHODS: This prospective cohort study enrolled randomly selected patients during an acute hospitalization at a children's hospital during 2012 to 2014. Demographic and clinical data were abstracted from administrative sources and caregiver questionnaires on admission through 30 days postdischarge. Medical home experience was assessed by using Maternal and Child Health Bureau definitions. Primary outcomes were 30-day unplanned readmission and 7-day ED visits to any hospital. Logistic regression explored relationships between outcomes and medical home experiences. RESULTS:We followed 701 patients, 97% with complete data. Thirty-day unplanned readmission and 7-day ED revisit rates were 12.4% and 5.6%, respectively. More than 65% did not have a medical home. In adjusted models, those with medical home component "having a usual source of sick and well care" had fewer readmissions than those without (adjusted odds ratio 0.54, 95% confidence interval 0.30-0.96). Readmissions were higher among those with less parent confidence in avoiding a readmission, subspecialist primary care providers, longer length of index stay, and more hospitalizations in the past year. ED visits were associated with lack of parent confidence but not medical home components.CONCLUSIONS: Lacking a usual source for care was associated with readmissions. Lack of parent confidence was associated with readmissions and ED visits. This information may be used to target interventions or identify high-risk patients before discharge. WHAT'S KNOWN ON THIS SUBJECT:Receiving primary care in a high-quality medical home may lead to reductions in hospital or emergency department (ED) utilization; however, the relationship between the medical home and postdischarge hospitalizations and ED visits is poorly understood.WHAT THIS STUDY ADDS: Readmission rates vary markedly based on data source and definition. Unplanned readmissions were associated with absence of a usual source of well and sick care but not other medical home components. Lack of parent confidence at discharge identified patients at high risk for readmissions and ED visits shortly after discharge.

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Section: Medical Home and Usual Source For Carementioning

confidence: 94%

Section: What This Study Addsmentioning

confidence: 99%

The Medical Home and Hospital Readmissions

et al. 2015

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“…For this study, previously programmed hospital admissions were left out of account, that is to say, those that did not correspond to a worsening of the child's clinical condition, such as voluntary surgeries and admissions for periodic administration of medication. Similarly, a US study which aimed to analyze the association between outpatient accompaniment of children with medical complexity and re-hospitalizations within the first 30 days after hospital discharge also left planned admissions out of account (11) . The number of involuntary admissions in the prior year ( January 1 through December 31, 2010) was considered as a dependent variable or a response variable, and classified as numerical.…”

Section: Methodsmentioning

confidence: 99%

Factors associated with involuntary hospital admissions in technology-dependent children

Okido

Pina

Lima

2016

Rev. esc. enferm. USP

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Objective:To identify the factors associated with involuntary hospital admissions of technology-dependent children, in the municipality of Ribeirão Preto, São Paulo State, Brazil. Method: A cross-sectional study, with a quantitative approach. After an active search, 124 children who qualified under the inclusion criteria, that is to say, children from birth to age 12, were identified. Data was collected in home visits to mothers or the people responsible for the children, through the application of a questionnaire. Analysis of the data followed the assumptions of the Generalized Linear Models technique. Results: 102 technology-dependent children aged between 6 months and 12 years participated in the study, of whom 57% were male. The average number of involuntary hospital admissions in the previous year among the children studied was 0.71 (±1.29). In the final model the following variables were significantly associated with the outcome: age (OR=0.991; CI95%=0.985-0.997), and the number of devices (OR=0.387; CI95%=0.219-0.684), which were characterized as factors of protection and quantity of medications (OR=1.532; CI95%=1.297-1.810), representing a risk factor for involuntary hospital admissions in technology-dependent children. Conclusion: The results constitute input data for consideration of the process of care for technology-dependent children by supplying an explanatory model for involuntary hospital admissions for this client group. DESCRIPTORSChild; Hospitalization; Pediatric Nursing. Factors associated with involuntary hospital admissions in technology-dependent childrenFatores associados às internações não eletivas em crianças dependentes de tecnologia Factores asociados con las hospitalizaciones no electivas en niños dependientes de tecnología

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“…Although some studies observe positive relationships between specific activities and reduced postdischarge utilization, 1 others suggest no relationship [9][10][11][12] or, paradoxically, more utilization. 13, 14 Brittan et al 15 found that outpatient visits were associated with more readmissions when occurring less than 4 days after discharge, but fewer readmissions when occurring 4 days to 29 days after discharge. Most studies, however, investigate single or limited sets of care activities, such as having an outpatient visit, 15 timeliness of that visit, 16 or receipt of a discharge summary.…”

confidence: 99%

“…13, 14 Brittan et al 15 found that outpatient visits were associated with more readmissions when occurring less than 4 days after discharge, but fewer readmissions when occurring 4 days to 29 days after discharge. Most studies, however, investigate single or limited sets of care activities, such as having an outpatient visit, 15 timeliness of that visit, 16 or receipt of a discharge summary. 11 Inclusion of a more comprehensive set of hospital-to primary-care communication practices may better unravel this complex relationship between discharge care and postdischarge outcomes for children.…”

confidence: 99%