Young Children Who Miss Well-Child Visits More Likely to be Hospitalized

Young children who missed more than half of recommended well-child visits had up to twice the risk of hospitalization compared to children who attended most of their visits according to a study published in the American Journal of Managed Care.

Most children in the study (76 percent) attended at least three-quarters of the recommended visits, for which Group Health required no copayment. The authors say the lack of copayment is an important incentive and likely one reason for such good adherence to visits among the study population.

Children with chronic conditions like asthma and heart disease were even more likely to be hospitalized when they missed visits, according to the study, which included more than 20,000 children enrolled at Group Health Cooperative. And children with chronic conditions who missed more than half of the recommended well-child visits had more than three times the risk of being hospitalized compared to children with chronic conditions who attended most of their visits.

The study included 20,065 children who were enrolled in Group Health from 1999 to 2006. Researchers followed the children from birth until age 3.5 years or until their first hospital stay, whichever came first.

During the study period, Group Health recommended nine well-child visits between birth and 3.5 years. The visits start at three to five days and continue at 1, 2, 4, 6, 10 and 15 months, and at 2 and 3.5 years.

Overall, four percent of children in the study — and 9 percent of children with chronic conditions — were hospitalized. The two most common reasons for hospitalization in both groups were pneumonia and asthma.

Children who missed more than half of their visits had 1.4 to 2.0 times the risk of hospitalization compared to those who attended most of their visits. Children with chronic conditions who missed more than half of their visits had 1.9 to 3.2 times the risk of hospitalization compared to those who attended most of their visits.

Authors caution that their findings might not apply to all health systems because the study was conducted in an integrated healthcare system where the majority of children attend most of their well-child visits and tend to have families with higher-than-average income and education. The authors were unable to adjust for income, education, race or ethnicity.

This study does not prove that missing well-child visits will increase the chance of hospitalization, although it does show an important association between these factors. The authors say one important reason for this link is that well-child visits allow for preventive care that keeps children from ending up in the hospital. An alternative explanation is that parents who miss well-child visits are also less likely to manage their children’s illnesses and follow treatment regimens, which could result in higher rates of hospitalization.

Source: Kaiser Permanente, May 24, 2013

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