Consistent source of care is key factor in limiting kids' repeat visits to the hospital

November 03, 2015

It's a question of major importance to parents, health policy makers and health care professionals -- and a focus of national health care quality improvement initiatives. What keeps children from being readmitted to hospitals in the weeks after they're discharged?

Previous research on the subject has focused on the role that hospitals play in the equation. But a new study by doctors at UCLA looked at five factors revolving around the primary physician's office.

Those factors, collectively known as the "primary care medical home," consider whether the child has a personal doctor or nurse, a "usual place" to receive sick and well care, "family-centered care" (which addresses family's overall needs rather than just the illness), an easy time obtaining referrals to specialists, and coordinated care (in which seamless care occurs across specialties, providers and systems).

It turned out that just one of those medical home factors was the most reliable predictor of whether a child would be readmitted to a hospital or emergency room within a month after being discharged: having a routine place to receive sick and well care.

Among children without a consistent place to receive well and sick care, 22 percent were readmitted to the hospital within a month; among those who did have a consistent place for well and sick care, just 10 percent were. In addition, 8 percent of children without a usual place for well and sick care went to a hospital emergency department within seven days of their discharge, versus just 5 percent of children who did have a usual source for well and sick care.

The research was published online in the journal Pediatrics.

The medical home model of care represents the cornerstone of pediatric primary care, especially for patients with special health care needs. But data to support whether or how much it improves health outcomes -- particularly in terms of reducing hospital use -- is still emerging.

"Our findings support the notion that medical homes that can ensure a usual source for both well and sick care, and can bolster a parent's level of confidence in caring for their child at home, might be able to better help patients avoid the need to be hospitalized again shortly after discharge," said Dr. Thomas Klitzner, a co-author of the study and a professor of pediatric cardiology at Mattel Children's Hospital UCLA. "These indicators could help us flag high-risk patients so that we can provide a higher level of support," said Klitzner, who also is executive director of the UCLA Pediatric Medical Home Program.

The study also revealed that parents' level of confidence in their children's continued good health was closely correlated with whether the child would be readmitted.

"When we asked parents upon discharge how confident they felt about their child not coming back to the hospital, we learned that having more confidence was associated with fewer unplanned readmissions or visits to the emergency department," said Dr. Ryan Coller, the study's lead author, a former UCLA faculty member who now is an assistant professor of pediatrics at the University of Wisconsin School of Medicine and Public Health. "If parents don't believe they can succeed at home, then that is a red flag."

From October 2012 through January 2014, the researchers tracked 701 children who had been hospitalized at UCLA for more than 24 hours. Researchers called the children's families within one week after they were discharged and again 30 days later to ask if the child had been hospitalized or visited an emergency room.

Among the families surveyed, 65 percent did not have a "medical home," meaning that they were missing at least one of the five criteria. Of those families, 65 percent did not have access to a usual source for well and sick care.

Those who did have a medical home were more likely to have commercial health insurance, were more likely to consider a generalist rather than a specialist to be their primary physician and their health problems were less complex. And, at the time the children were discharged, parents of children with a medical home tended to be more confident that their children would avoid a return visit to the hospital or emergency room.

The next phase of the research will examine hospitals' transition practices and the transfer of patient care from inpatient providers to medical home providers.
-end-
The study was conducted by the Children's Discovery and Innovation Institute at UCLA. It was funded by grants from the Lucile Packard Foundation for Children's Health and the Health Resources and Services Administration.

Other authors were Adrianna Saenz, Dr. Carlos Lerner, Dr. Bergen Nelson and Dr. Paul Chung, all of UCLA. The authors have no financial relationships relevant to the article to disclose.

University of California - Los Angeles Health Sciences

Related Emergency Department Articles from Brightsurf:

Deep learning in the emergency department
Harnessing the power of deep learning leads to better predictions of patient admissions and flow in emergency departments

Checklist for emergency department team's COVID-19 surge
After reviewing the literature on COVID-19 scientific publications the authors developed a checklist to guide emergency departments.

Why is appendicitis not always diagnosed in the emergency department?
A new study examines the factors associated with a potentially missed diagnosis of appendicitis in children and adults in the emergency department.

Providing contraceptive care in the pediatric emergency department
A new study found that two-thirds of female adolescents ages 16-21 seen in a pediatric Emergency Department (ED) were interested in discussing contraception, despite having a high rate of recent visits to a primary care provider.

Low back pain accounts for a third of new emergency department imaging in the US
The use of imaging for the initial evaluation of patients with low back pain in the emergency department (ED) continues to occur at a high rate -- one in three new emergency visits for low back pain in the United States -- according to the American Journal of Roentgenology (AJR).

Emergency department admissions of children for sexual abuse
This study analyzed emergency department admissions of children for sexual abuse between 2010 and 2016 using a nationwide database of emergency visits and US Census Bureau data.

30-day death rates after emergency department visits
Researchers used Medicare data from 2009 to 2016 to see how 30-day death rates associated with emergency department visits have changed.

Preventing smoking -- evidence from urban emergency department patients
A new study from the Prevention Research Center of the Pacific Institute for Research and Evaluation offers a more in-depth understanding of smoking among patients in an urban emergency department.

When a freestanding emergency department comes to town, costs go up
Rather than functioning as substitutes for hospital-based emergency departments, freestanding emergency departments have increased local market spending on emergency care in three of four states' markets where they have entered, according to a new paper by experts at Rice University.

Emoji buttons gauge emergency department sentiments in real time
Simple button terminals stationed around emergency departments featuring 'emoji' reflecting a range of emotions are effective in monitoring doctor and patient sentiments in real time.

Read More: Emergency Department News and Emergency Department Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.