RT Journal
A1 Tom JO, Tseng C, Davis J, Solomon C, Zhou C, Mangione-Smith R
T1 MIssed well-child care visits, low continuity of care, and risk of ambulatory care–sensitive hospitalizations in young children
JF Archives of Pediatrics & Adolescent Medicine
JO Archives of Pediatrics & Adolescent Medicine
YR 2010
FD November 1
VO 164
IS 11
SP 1052
OP 1058
DO 10.1001/archpediatrics.2010.201
UL http://dx.doi.org/10.1001/archpediatrics.2010.201
AB Objectives 
    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.Design 
    Population-based, retrospective cohort study.Setting 
    Hawaii's largest health plan from 1999 to 2006.Participants 
    A total of 36 944 children aged 3.5 years or younger were eligible if they were enrolled prior to 2 months of age, had 4 or more outpatient visits during the study period, and had an enrollment period that overlapped with 1 or more WCC visit interval.Main Exposure 
    Patients' WCC visit adherence and COC index.Main Outcome Measure 
    Risk of ACSH (hazard ratio [HR]).Results 
    Overall, 8921 (24%) children had 1 or more chronic disease. The proportion of ACSH among healthy children vs those with 1 or more chronic disease were 3% (n = 751) and 7% (n = 645), respectively. For children with chronic disease, those with the lowest WCC visit adherence (0%-25%) had 1.9 times (HR, 1.9; 95% confidence interval [CI], 1.5-2.5) the risk of ACSH compared with those in the highest category (75%-100%). The risk of ACSH for children with chronic disease who fell into the lowest COC category (0-0.25) was 2.4 times (HR, 2.4; 95% CI, 1.7-3.5) higher than for those who fell into the highest category (0.75-1.0).Conclusions 
    For children with chronic disease, both low WCC visit adherence and COC are independently associated with an increased risk of ACSH. Providing access to a consistent source of primary care appears to be important to this vulnerable population.