Well-child care visits and risk of ambulatory care-sensitive hospitalizations
Kaiser Permanente Center for Health Research, Hawaii, 501 Alakawa St, Ste 201, Honolulu, HI96817. E-mail: . The American journal of managed care
(Impact Factor: 2.26).
Objectives: To determine if poor well-child care (WCC) visit adherence is associated with increased risk for Ambulatory Care-Sensitive Hospitalizations (ACSHs) among young children in an integrated healthcare delivery system. Study Design: This was a retrospective observational study. Methods: We used claims and administrative data for children aged 2 months to 3.5 years enrolled at Group Health Cooperative from 1999 to 2006. Our main independent variable was timely WCC visits based on Group Health's 2000 recommended schedule. We used Cox proportional hazard regression models to determine the association between WCC visit adherence and risk for a child's first ACSH. Results: Of the 20,065 children, 797 (4%) had an ACSH. Children with lower WCC visit adherence had increased hazard ratios (HRs) of 1.4-2.0 for ACSH (adherence 0-25%: HR 2.0, 95% confidence interval [CI]: 1.6-2.6, P < .001; adherence 26-50%: HR 1.4, 95% CI: 1.1-1.8, P < .05). Of the 2196 children with > 1 chronic disease, 189 (9%) had an ACSH. Children with > 1 chronic disease and with lower WCC visit adherence also had increased HRs for ACSH (adherence 0-25%: HR 3.2, 95% CI: 1.8-5.6, P < .001; adherence 26-50%: HR 1.9, 95% CI: 1.2-3.2, P < .05). Conclusions: For young children, poor WCC visit adherence was associated with increased risk for ACSH in this integrated healthcare delivery system.
Available from: Paul S Carbone
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To compare the prevalence of hospitalizations for ambulatory care sensitive conditions (ACSC) in children with and without autism spectrum disorder (ASD) and to compare inpatient health care utilization (total charges and length of stay) for the same conditions in children with and without ASD.
The 2009 Kids' Inpatient Database was used to examine hospitalizations for ACSC in children within 3 cohorts: those with ASD, those with chronic conditions (CC) without ASD, and those with no CC.
The proportion of hospitalizations for ACSC in the ASD cohort was 55.9%, compared with 28.2% in the CC cohort and 22.9% in the no-CC cohort (P < .001). Hospitalized children with ASD were more likely to be admitted for a mental health condition, epilepsy, constipation, pneumonia, dehydration, vaccine-preventable diseases, underweight, and nutritional deficiencies compared with the no-CC cohort. Compared with the CC cohort, the ASD cohort was more likely to be admitted for mental health conditions, epilepsy, constipation, dehydration, and underweight. Hospitalized children with ASD admitted for mental health conditions had significantly higher total charges and longer LOS compared with the other 2 cohorts.
The proportion of potentially preventable hospitalizations is higher in hospitalized children with ASD compared with children without ASD. These data underscore the need to improve outpatient care of children with ASD, especially in the areas of mental health care and seizure management. Future research should focus on understanding the reasons for increased inpatient health care utilization in children with ASD admitted for mental health conditions.
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