Medical home model keeps children out of the hospital

Children who have a consistent place to receive well and sick care are less likely to be readmitted to a hospital in the weeks after discharge compared to those who didn't have a primary care provider, according to a new study.

The study, conducted by doctors at UCLA and published online in the journal Pediatrics, followed 701 patients who were hospitalized at UCLA for more than 24 hours at some point from October 2012 through January 2014 to examine the role of the primary physician's office and the primary care medical home in readmissions. Researchers called the children's families within one week after they were discharged and again 30 days later to ask if the child had been hospitalized or visited an emergency room.

Researchers looked at five factors: whether the child has a personal doctor or nurse, a consistent place to receive sick and well care, family-centered care, an easy time obtaining referrals to specials and coordinated care across specialties, providers and systems. Among the families surveyed, 65 percent did not have a "medical home," which meant they missed at least one of the five criteria. Of those families, 65 percent did not have access to a usual source for well and sick care.

The most reliable indicator of readmission was whether the child had a routine place to receive care, according to the study.

Twenty-two percent of the children who didn't have a primary care office returned to the hospital within a month and 8 percent sought care in the emergency department within seven days of discharge. But only 10 percent of children who did have a routine place to receive care were readmitted to the hospital within 30 days and just 5 percent went to a hospital ER within seven days of discharge.

"Our findings support the notion that medical homes that can ensure a usual source for both well and sick care, and can bolster a parent's level of confidence in caring for their child at home, might be able to better help patients avoid the need to be hospitalized again shortly after discharge," co-author Thomas Klitzner, M.D., Ph.D., a professor of pediatric cardiology at Mattel Children's Hospital UCLA and the executive director of the UCLA Pediatric Medical Home Program, said in a study announcement.

"These indicators could help us flag high-risk patients so that we can provide a higher level of support," he said.

Another key factor for readmissions is the parents' level of confidence in their children's continued good health, according to the study authors.

"When we asked parents upon discharge how confident they felt about their child not coming back to the hospital, we learned that having more confidence was associated with fewer unplanned readmissions or visits to the emergency department," lead author Ryan Coller, M.D., a former UCLA faculty member who now is an assistant professor of pediatrics at the University of Wisconsin School of Medicine and Public Health, said in the announcement. "If parents don't believe they can succeed at home, then that is a red flag."

The research also found that patients who did have a medical home were more likely to have commercial health insurance, were more likely to consider a generalist rather than a specialist to be their primary physician and their health problems were less complex. And, at the time the children were discharged, parents of children with a medical home tended to be more confident that their children would avoid a return visit to the hospital or emergency room.

To learn more:
- here's the study abstract
- read the announcement

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