Missed well-child care visits, low continuity of care, and risk of ambulatory care-sensitive hospitalizations in young children

Arch Pediatr Adolesc Med. 2010 Nov;164(11):1052-8. doi: 10.1001/archpediatrics.2010.201.


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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Ambulatory Care / statistics & numerical data*
  • Chi-Square Distribution
  • Chronic Disease*
  • Continuity of Patient Care*
  • Female
  • Hawaii
  • Hospitalization / statistics & numerical data*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Patient Compliance*
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk
  • Vulnerable Populations