Timely Primary Care Follow-Up Following Hospitalization for Pediatric Critical Illness.

Abstract

Timely follow-up after PICU hospitalization provides an important opportunity to support recovery following critical illness. However, the limited available data suggest that timely follow-up does not occur regularly. What are the rate of and factors associated with timely follow-up with primary and/or specialty care clinicians following PICU hospitalization? Using the Merative MarketScan Commercial Database and the Transformed Medicaid Statistical Information System Analytic Files, this study identified PICU hospitalizations for publicly and privately insured children (age 0-18 years) with a PICU hospitalization from January 2016 to December 2019. Primary and/or subspecialty visits within 7 days of PICU hospitalization discharge were analyzed. Multivariable logistic regression was used to report the adjusted probability of timely follow-up according to patient and hospitalization characteristics. Among 333,920 and 41,223 eligible PICU hospitalizations for publicly and privately insured children, 149,028 (44.6%) and 19,037 (46.2%) were for female participants and 178,295 (53.4%) and 27,294 (66.2%) were for children with a complex chronic condition, respectively. In the 7 days after discharge from PICU hospitalization, 82,009 (24.6%) and 12,299 (29.8%) of hospitalizations for publicly and privately insured children had primary care follow-up within 7 days of PICU hospitalization discharge; 29,623 (8.9%) and 4,099 (9.9%) had subspecialty follow-up, and 102,631 (30.7%) and 15,412 (37.4%) had any outpatient follow-up. In adjusted analyses, younger age and lack of complex chronic conditions were associated with a higher likelihood of primary care follow-up. In this US cohort of > 375,000 critically ill children with public or private insurance, less than one-third had primary care follow-up within 1 week of hospital discharge. Younger children and children without chronic conditions were more likely to have primary care follow-up. Children who survive PICU hospitalization may benefit from specific follow-up recommendations to ensure continuity in care.