Well-Child Care Visits and Risk of Ambulatory Care-Sensitive Hospitalizations

Objectives: To determine if poor well-child care (WCC) visit adherence is associated with increased risk for Ambulatory Care Sensitive Hospitalizations (ACSHs) among young children in an integrated healthcare delivery system. Study Design: This was a retrospective observational study. Methods: We used claims and administrative data for children aged 2 months to 3.5 years enrolled at Group Health Cooperative from 1999 to 2006. Our main independent variable was timely WCC visits based on Group Health's 2000 recommended schedule. We used Cox proportional hazard regression models to determine the association between WCC visit adherence and risk for a child's first ACSH. Results: Of the 20,065 children, 797 (4%) had an ACSH. Children with lower WCC visit adherence had increased hazard ratios (HRs) of 1.4-2.0 for ACSH (adherence 0-25%: HR 2.0, 95% confidence interval [CI]: 1.6-2.6, P < .001; adherence 26-50%: HR 1.4, 95% Cl: 1.1-1.8, P < .05). Of the 2196 children with >= 1 chronic disease, 189 (9%) had an ACSH. Children with chronic disease and with lower WCC visit adherence also had increased HRs for ACSH (adherence 0-25%: HR 3.2, 95% CI: 1.8-5.6, P < .001; adherence 26-50%: HR 1.9, 95% CI: 1.2-3.2, P < .05). Conclusions: For young children, poor WCC visit adherence was associated with increased risk for ACSH in this integrated healthcare delivery system.