Hospitalizations for Ambulatory Care-Sensitive Conditions among Children with Chronic and Complex Diseases

doi:10.1016/j.jpeds.2017.10.038

The Journal of Pediatrics

Volume 194, March 2018, Pages 218-224

https://doi.org/10.1016/j.jpeds.2017.10.038 Get rights and content

Objective

To evaluate ambulatory-care sensitive (ACS) hospitalizations for children with noncomplex chronic diseases (NC-CD) and children with medical complexity (CMC), and identify associations with ambulatory care characteristics. Although ACS hospitalizations are potentially preventable in general populations, the specific ambulatory care predictors and influence of medical complexity on them is poorly understood.

Study design

Retrospective cohort study of NC-CD and CMC hospitalizations at a children's hospital during 2007-2014, excluding labor/delivery and children over 21 years. Pediatric medical complexity algorithm identified NC-CD or CMC. ACS hospitalizations were identified using Agency for Healthcare Research and Quality indicator definitions. Demographic and ambulatory care characteristics were compared between ACS and non-ACS hospitalizations with logistic regression clustered by patient. Measures of ambulatory care during 2 years before admission were explored with 20% random sample of general pediatrics discharges.

Results

Among 4035 children with NC-CD, 14.6% of 4926 hospitalizations were ACS hospitalizations. Among 5084 CMC, 5.3% of 14 390 discharges were ACS hospitalizations. Among NC-CD discharges, ACS hospitalizations were more likely with no prior-year outpatient visits (OR 1.4, 95% CI 1.1-1.7) and less likely with timely well checks (OR 0.8, 95% CI 0.6-0.9) and phone encounters in the month before admission (OR 0.5, 95% CI 0.2-1.0). Among CMC discharges, the only association observed was with provider continuity (OR 0.3, 95% CI 0.1- 1.0).

Conclusions

Provider continuity may be associated with fewer CMC ACS hospitalizations, however, measures of ambulatory care were more consistently associated with ACS hospitalizations for NC-CD. CMC may need more precise ACS hospitalization definitions.

Section snippets

Methods

This retrospective cohort study included pediatric discharges from a tertiary children's hospital between July 2007 and July 2014. We used the pediatric medical complexity algorithm to categorize patients into 3 mutually exclusive groups: (1) nonchronic, (2) noncomplex chronic, or (3) complex chronic disease.¹⁵ We included encounters for patients with noncomplex chronic disease (NC-CD) or complex chronic diseases (ie, CMC). NC-CDs typically involve only a single body system, are nonprogressive,

Results

Among 4035 NC-CD, 14.6% of the 4926 discharges were for ACSCs; whereas among 5084 CMC, 5.3% of the 14 390 discharges were for ACSCs. The most common ACSCs were asthma in the NC-CD group and pneumonia in the CMC group (Figure 1). Encounter characteristics are summarized in Table I. In the chart review sample, which was comprised of discharges from the hospital medicine service who received primary care within our health system, 118 children with NC-CD had 120 hospitalizations (38.3% for ACSCs)

Discussion

Despite the assumption that hospitalizations because of ACSCs are avoidable through high-quality ambulatory care, empiric support for this concept in pediatrics is needed. Our study findings suggest that measures of ambulatory care are related to ACS hospitalization but also suggest that underlying health status may be an important moderator of these relationships, and among CMC, hospitalizations for these conditions may be less sensitive to ambulatory care. Multiple ambulatory care measures

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: Supported in part by the Clinical and Translational Science Award (CTSA) program, through the National Institutes of Health National Center for Advancing Translational Sciences (NCATS) (UL1TR000427). The authors declare no conflicts of interest.

View full text

Original ArticlesHospitalizations for Ambulatory Care-Sensitive Conditions among Children with Chronic and Complex Diseases

Objective

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

Acad Pediatr

Disabil Health J

Impact of socioeconomic status on hospital use in New York City

Health Aff

Technical Report: Measures of Pediatric Health Care Quality Based on Hospital Administrative Data: The Pediatric Quality Indicators

Conditions for which onset or hospital admission is potentially preventable by timely and effective ambulatory care

J Health Serv Res Policy

Missed well-child care visits, low continuity of care, and risk of ambulatory care-sensitive hospitalizations in young children

Arch Pediatr Adolesc Med

Medicaid re-enrollment policies and children's risk of hospitalizations for ambulatory care sensitive conditions

Med Care

Children with medical complexity: an emerging population for clinical and research initiatives

Pediatrics

Hospital utilization and characteristics of patients experiencing recurrent readmissions within children's hospitals

JAMA

Health Care Costs: A Primer

The landscape of medical care for children with medical complexity

Children with medical complexity and Medicaid: spending and cost savings

Health Aff

Patterns and costs of health care use of children with medical complexity

Pediatrics

Profile of medical charges for children by health status group and severity level in a Washington State Health Plan

Health Serv Res

Pediatric medical complexity algorithm: a new method to stratify children by medical complexity

Pediatrics

Pediatric Quality Indicators Technical Specifications - Version 5.0

Quality measures for primary care of complex pediatric patients

Pediatrics

Disentangling the linkage of primary care features to patient outcomes: a review of current literature, data sources, and measurement needs

J Gen Intern Med

Original Articles
Hospitalizations for Ambulatory Care-Sensitive Conditions among Children with Chronic and Complex Diseases