title: Well-child care visits and risk of ambulatory care-sensitive hospitalizations.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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% CI: 1.1-1.8, P < .05). Of the 2196 children with > 1 chronic disease, 189 (9%) had an ACSH. Children with > 1 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.
authors.affiliation: Kaiser Permanente Center for Health Research, Hawaii, 501 Alakawa St, Ste 201, Honolulu, HI96817. jeffrey.o.tom@kp.org
authors.forename: Jeffrey O
authors.initials: JO
authors.lastname: Tom
authors.forename: Rita
authors.initials: R
authors.lastname: Mangione-Smith
authors.forename: David C
authors.initials: DC
authors.lastname: Grossman
authors.forename: Cam
authors.initials: C
authors.lastname: Solomon
authors.forename: Chien-Wen
authors.initials: CW
authors.lastname: Tseng
mesh_terms: D000553:Ambulatory Care; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007223:Infant; D007345:Insurance Claim Review; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014481:United States