Outpatient Follow-Up Visits and Readmission in Medically Complex Children Enrolled in Medicaid

• Published in: The Journal of pediatrics Vol. 166; no. 4; pp. 998 - 1005.e1
• Main Authors: Brittan, Mark S., MD, MPH, Sills, Marion R., MD, Fox, David, MD, Campagna, Elizabeth J., MS, Shmueli, Doron, MS, Feinstein, James A., MD, MPH, Kempe, Allison, MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2015
• Subjects: Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Infant; Length of Stay - economics; Length of Stay - statistics & numerical data; Male; Medicaid - economics; Medicaid - statistics & numerical data; Outpatients - statistics & numerical data; Patient Discharge - statistics & numerical data; Patient Readmission - economics; Patient Readmission - statistics & numerical data; Pediatrics; Retrospective Studies; Risk Factors; United States; United States; LOS; ICD-9; Emergency department; International Classification of Diseases, Ninth Revision; Current Procedural Terminology, 4th edition; PCCM; CPT-4; MDC; Primary care case management; Major diagnostic category; ED; Length of stay
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2014.12.022

Objective To examine the association between postdischarge outpatient follow-up and 30-day readmissions in Medicaid enrolled children with complex, chronic conditions. Study design This was a retrospective cohort analysis of Colorado Medicaid recipients with complex, chronic conditions who were discharged from the hospital between 2006 and 2008. The primary outcome was readmission between 4 and 30 days after index hospital discharge. Using multivariable logistic regression, we examined the association between early postdischarge outpatient visits (≤3 days postdischarge) and readmission. We secondarily analyzed the relationship between any outpatient visit from 4 to 29 days of index discharge and readmission. Results For the 2415 patients with complex, chronic conditions included in the analysis, the 4- to 30-day readmission rate was 6.3%. The odds of readmission was significantly greater for patients with ≥1 outpatient visit ≤3 days after discharge compared with patients without a visit ≤3 days after discharge (aOR 1.7 [1.1-2.4]). The odds of readmission were significantly lower for patients with ≥1 outpatient visit from 4 to 29 days after discharge compared with patients without such visits (aOR 0.5 [0.3-0.7]). Other factors associated with readmission included index hospital length of stay and number of complex, chronic conditions. Conclusions In medically complex children, there is a positive association between early postdischarge outpatient follow-up and readmission. There is an inverse association between later postdischarge outpatient follow-up and readmission. Outpatient follow-up occurring within 4-29 days after discharge may help to prevent 30-day readmissions. Additional research is needed to inform guidelines regarding longer term postdischarge outpatient follow-up in these children.