Tom Jeffrey O, Tseng Chien-Wen, Davis James, Solomon Cam, Zhou Chuan, Mangione-Smith Rita
Kaiser Center for Health Research-Hawaii, 501 Alakawa Street, Honolulu, HI 96817, USA.
Arch Pediatr Adolesc Med. 2010 Nov;164(11):1052-8. doi: 10.1001/archpediatrics.2010.201.
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.
Population-based, retrospective cohort study.
Hawaii's largest health plan from 1999 to 2006.
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.
Patients' WCC visit adherence and COC index.
Risk of ACSH (hazard ratio [HR]).
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).
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.
确定坚持推荐的儿童健康护理（WCC）就诊计划（独立于连续护理（COC））是否与门诊护理敏感型住院（ACSH）风险较低相关，以及这种关联是否因慢性病状况而异。
基于人群的回顾性队列研究。
1999年至2006年夏威夷最大的健康计划。
共有36944名3.5岁及以下儿童符合条件，前提是他们在2个月龄之前登记，在研究期间有4次或更多次门诊就诊，并且登记期与1个或更多WCC就诊间隔重叠。
患者的WCC就诊依从性和COC指数。
ACSH风险（风险比[HR]）。
总体而言，8921名（24%）儿童患有1种或更多种慢性病。健康儿童与患有1种或更多种慢性病儿童的ACSH比例分别为3%（n = 751）和7%（n = 645）。对于患有慢性病的儿童，WCC就诊依从性最低（0%-25%）的儿童与最高类别（75%-100%）的儿童相比，ACSH风险高1.9倍（HR，1.9；95%置信区间[CI]，1.5-2.5）。COC类别最低（0-0.25）的慢性病儿童的ACSH风险比最高类别（0.75-1.0）的儿童高2.4倍（HR，2.4；95%CI，1.7-3.5）。
对于患有慢性病的儿童，低WCC就诊依从性和COC均与ACSH风险增加独立相关。为这一弱势群体提供持续的初级保健来源似乎很重要。
