title: Outpatient follow-up visits and readmission in medically complex children enrolled in Medicaid.
abstract: OBJECTIVE
  To examine the association between postdischarge outpatient follow-up and 30-day readmissions in Medicaid enrolled children with complex, chronic conditions.
  
  
  METHODS
  This was a retrospective cohort analysis of Colorado Medicaid recipients with complex, chronic conditions who were discharged from the hospital between 2006 and 2008. The primary outcome was readmission between 4 and 30 days after index hospital discharge. Using multivariable logistic regression, we examined the association between early postdischarge outpatient visits (≤ 3 days postdischarge) and readmission. We secondarily analyzed the relationship between any outpatient visit from 4 to 29 days of index discharge and readmission.
  
  
  RESULTS
  For the 2415 patients with complex, chronic conditions included in the analysis, the 4- to 30-day readmission rate was 6.3%. The odds of readmission was significantly greater for patients with ≥ 1 outpatient visit ≤ 3 days after discharge compared with patients without a visit ≤ 3 days after discharge (aOR 1.7 [1.1-2.4]). The odds of readmission were significantly lower for patients with ≥ 1 outpatient visit from 4 to 29 days after discharge compared with patients without such visits (aOR 0.5 [0.3-0.7]). Other factors associated with readmission included index hospital length of stay and number of complex, chronic conditions.
  
  
  CONCLUSIONS
  In medically complex children, there is a positive association between early postdischarge outpatient follow-up and readmission. There is an inverse association between later postdischarge outpatient follow-up and readmission. Outpatient follow-up occurring within 4-29 days after discharge may help to prevent 30-day readmissions. Additional research is needed to inform guidelines regarding longer term postdischarge outpatient follow-up in these children.
authors: Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Children's Outcome Research Program, University of Colorado School of Medicine, Aurora, CO. Electronic address: mark.brittan@childrenscolorado.org.
authors: Mark S
authors: MS
authors: Brittan
authors: Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Children's Outcome Research Program, University of Colorado School of Medicine, Aurora, CO.
authors: Marion R
authors: MR
authors: Sills
authors: Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Children's Outcome Research Program, University of Colorado School of Medicine, Aurora, CO.
authors: David
authors: D
authors: Fox
authors: Children's Outcome Research Program, University of Colorado School of Medicine, Aurora, CO.
authors: Elizabeth J
authors: EJ
authors: Campagna
authors: Children's Outcome Research Program, University of Colorado School of Medicine, Aurora, CO.
authors: Doron
authors: D
authors: Shmueli
authors: Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Children's Outcome Research Program, University of Colorado School of Medicine, Aurora, CO.
authors: James A
authors: JA
authors: Feinstein
authors: Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Children's Outcome Research Program, University of Colorado School of Medicine, Aurora, CO.
authors: Allison
authors: A
authors: Kempe
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data*; D010045:Outpatients / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States