Division of Critical Care, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA.
Department of Pediatrics, Central Michigan University, Mount Pleasant, Michigan, USA.
Pediatr Pulmonol. 2021 Jun;56(6):1745-1753. doi: 10.1002/ppul.25343. Epub 2021 Mar 13.
To characterize the recommended posthospitalization follow-up by provider type and location after a pediatric critical illness due to respiratory failure.
After pediatric critical illness due to respiratory failure, patients will not have a standard follow-up pattern with regard to provider type or follow-up location.
A retrospective cohort study.
Children, 18 years or younger, admitted to a quaternary care pediatric intensive care unit with respiratory failure between January 1, 2013 and December 31, 2014.
For eligible patients, recommendations for posthospitalization follow-up including provider type (primary care and specialty care) and location (community care center vs. tertiary care center) were characterized from medical chart review. Recommendations were examined for all patients and two patient subgroups (patients who received extracorporeal membrane oxygenation and patients with tracheostomy).
Of 155 patients alive at hospital discharge, the median age was 2.1 (interquartile range, 0.7-10.6) years. Eighty percent of patients were instructed to follow-up with a primary care provider but only 52.9% with a pulmonologist. We found 10 unique follow-up patterns between provider location (community care center, tertiary care center, or both) and global provider type (primary care versus specialty care). Primary care follow-up was recommended more often at community locations (74.2%), whereas specialty care was more often recommended at tertiary care centers (68.6%).
Our study findings demonstrate significant variability in the recommendations for follow-up by provider type and location after hospitalization for acute respiratory failure and highlight areas for improvement in follow-up care after pediatric critical illness.
描述因呼吸衰竭导致儿科危重症后，按提供者类型和位置推荐的住院后随访情况。
因呼吸衰竭导致儿科危重症后，患者在提供者类型或随访地点方面不会有标准的随访模式。
回顾性队列研究。
2013 年 1 月 1 日至 2014 年 12 月 31 日期间，因呼吸衰竭入住四级儿科重症监护病房的 18 岁或以下儿童。
对于符合条件的患者，通过病历回顾描述住院后随访的建议，包括提供者类型（初级保健和专科保健）和地点（社区保健中心与三级保健中心）。对所有患者和两个患者亚组（接受体外膜氧合的患者和气管造口术患者）进行了建议检查。
在出院时存活的 155 名患者中，中位年龄为 2.1 岁（四分位距，0.7-10.6）。80%的患者被指示由初级保健提供者进行随访，但只有 52.9%的患者由肺病专家进行随访。我们在提供者位置（社区保健中心、三级保健中心或两者兼有）和全球提供者类型（初级保健与专科保健）之间发现了 10 种独特的随访模式。社区位置更常推荐初级保健随访（74.2%），而专科保健更常推荐在三级保健中心（68.6%）。
我们的研究结果表明，急性呼吸衰竭住院后，在推荐的随访提供者类型和地点方面存在显著差异，突出了儿科危重病后随访护理方面有待改进的领域。
