TOPLINE

Children with medical complexity were less likely to complete primary care practitioner (PCP) follow-up within 14 days of hospital discharge than children without medical complexity. Among children with medical complexity who did attend PCP follow-up, the risks for readmission and emergency department (ED) visits were higher.

METHODOLOGY

• Researchers conducted a retrospective cohort study including 170,164 hospitalizations among children and adolescents aged 1-18 years (median age, 9 years; 51.1% boys) using the IBM MarketScan Commercial Database from 2017 to 2024.
• A total of 72,883 hospitalizations (42.8%) involved children identified as having medical complexity based on specific classification criteria.
• Researchers examined PCP follow-up visits within 14 days of discharge.
• Associations between PCP follow-up and 14-day outcomes were estimated; the outcomes were all-cause readmission, visits to the ED, the use of laboratory tests, and the receipt of imaging.

TAKEAWAY

• Children with medical complexity had lower odds of PCP follow-up than those without medical complexity (adjusted odds ratio, 0.82; 95% CI, 0.80-0.84).
• Among children with medical complexity, PCP follow-up was associated with a higher risk for all-cause readmission (adjusted hazard ratio [aHR], 1.31; 95% CI, 1.21-1.42) and ED visits (aHR, 1.15; 95% CI, 1.06-1.24).
• PCP follow-up was also associated with increased laboratory testing (aHR, 2.74; 95% CI, 2.64-2.85) and imaging (aHR, 1.30; 95% CI, 1.24-1.37) within 14 days.

IN PRACTICE

“[The study] findings should not be interpreted as evidence that PCP follow-up causes greater health care use. Instead, the observed association likely reflects residual confounding by indication, in which children with greater acuity, unresolved symptoms, or caregiver concern were both more likely to complete follow-up and more likely to require subsequent care,” the authors of the study wrote. “[The] findings suggest that uniform expectations for PCP follow-up in children with medical complexity do not align with actual practice,” they added.

SOURCE

The study was led by Nassr Nama, MD, MSc, of the Department of Pediatrics in the University of Washington School of Medicine at Seattle Children’s Hospital in Seattle. It was published online on July 23 as a research letter in JAMA Network Open.

LIMITATIONS

Claims data provided limited clinical detail to measure illness severity and could not distinguish scheduled follow-up from visits due to worsening symptoms or concerns. The study was restricted to commercially insured children. Nonbilled follow-up such as telephone check-ins or patient-centered outcomes such as family burden or reassurance could not be captured.

DISCLOSURES

One author was supported by the Seattle Children’s Research Institute Career Development Award. Another author reported receiving grants from the Agency for Healthcare Research and Quality and the National Institute of Child Health and Human Development unrelated to this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.