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Perceived Access to Outpatient Care and Hospital Reutilization Following Acute Respiratory Illnesses.

Authors :
Kenyon CC
Gruschow SM
Haaland WL
Desai AD
Adams SA
Hitt TA
Williams DJ
Johnson DP
Mangione-Smith R
Source :
Academic pediatrics [Acad Pediatr] 2019 May - Jun; Vol. 19 (4), pp. 370-377. Date of Electronic Publication: 2018 Jul 25.
Publication Year :
2019

Abstract

Objective: Efforts to decrease hospital revisits often focus on improving access to outpatient follow-up. Our objective was to assess the relationship between perceived access to timely office-based care and subsequent 30-day revisits following hospital discharge for 4 common respiratory illnesses.<br />Methods: This was a prospective cohort study of children 2 weeks to 16years admitted to 5 US children's hospitals for asthma, bronchiolitis, croup, or pneumonia between July 2014 and June 2016. Hospital and emergency department (ED) (in the case of croup) admission surveys administered to caregivers included the Consumer Assessments of Healthcare Providers and Systems Timely Access to Care. Access composite scores (range 0-100, with greater scores indicating better access) were linked with 30-day ED revisits and inpatient readmissions from the Pediatric Health Information System. The relationship between access to timely care and repeat utilization was assessed using multivariable logistic regression adjusting for demographics, hospitalization, and home/outpatient factors.<br />Results: Of the 2438 children enrolled, 2179 (89%) reported an office visit in the previous 6 months. Average access composite score was 52.0 (standard deviation, 36.3). In adjusted analyses, greater access scores were associated with greater odds of 30-day ED revisits (odds ratio [OR] = 1.07; 95% confidence interval [CI], 1.02-1.13)-particularly for croup (OR = 1.17; 95% CI, 1.02-1.36)-but not inpatient readmissions (OR = 1.02; 95% CI, 0.96-1.09).<br />Conclusions: Perceived access to timely office-based care was associated with significantly greater odds of subsequent ED revisit. Focusing solely on enhancing timely access to care following discharge for common respiratory illnesses may be insufficient to prevent repeat utilization.<br /> (Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1876-2867
Volume :
19
Issue :
4
Database :
MEDLINE
Journal :
Academic pediatrics
Publication Type :
Academic Journal
Accession number :
30053631
Full Text :
https://doi.org/10.1016/j.acap.2018.07.001