1. Presence of an established medical home was associated with a lower, unplanned admission rate within 30-days, but not associated with changes in 7-day Emergency Department (ED) visit rate, following hospital discharge in pediatric patients.
2. Pediatric patients with subspecialists as primary care providers, those with longer and more frequent hospitalizations at baseline, and those with less parental confidence in avoiding a readmission were more likely to be readmitted.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Reducing readmissions to the hospital or ED visits shortly following hospital discharge have become a mainstay of national healthcare improvement efforts, as these encounters are thought to be due to shortcomings in the discharge process. While most pediatric literature in this area thus far has focused on hospital determinants of repeat hospital visitation, this study instead looked at whether pediatric patients with an established medical home have fewer readmissions or ED visits following discharge. Researchers found that patients without a medical home, with less parental confidence in avoiding a readmission, with subspecialists as primary care providers, and those with longer and more frequent hospitalizations at baseline were more likely to be readmitted. ED visits following discharge were more likely among those with less parental confidence in avoiding a readmission, but were not associated with presence of a medical home. Though limited in its generalizability, this study suggests areas for intervention to prevent readmissions or ED visits following discharge.
In-Depth [prospective cohort]: This prospective cohort enrolled 701 pediatric patients being discharged from the inpatient service or the intensive care unit from October 2012 to January 2014 at a single tertiary medical center. Parents were interviewed immediately following discharge, and again via phone at the 7- and 30-day mark. At discharge and at 7 days, parents were asked, “How confident are you that [child’s name] will stay out of the hospital for the next 30 days?” amongst other questions. Parental data was integrated with patient medical records. The incidence of unplanned readmissions within 30 days and ED visits within 7 days following discharge were 12.4% and 5.6%, respectively. Using the Maternal and Child Health Bureau’s definition of medical home (personal doctor or nurse, usual source for sick and well care, family-centered care, no problem with referrals, coordinated care), 35% of enrolled patients had a medical home. Such patients with a medical home were less likely to have an unplanned readmission (adjusted OR: 0.54, 95%CI 0.30 – 0.96), but not less likely to have a 7-day ED visit.
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