title: The Medical Home and Hospital Readmissions.
abstract: OBJECTIVE
  Despite considerable attention, little is known about the degree to which primary care medical homes influence early postdischarge utilization. We sought to test the hypothesis that patients with medical homes are less likely to have early postdischarge hospital or emergency department (ED) encounters.
  
  
  METHODS
  This prospective cohort study enrolled randomly selected patients during an acute hospitalization at a children's hospital during 2012 to 2014. Demographic and clinical data were abstracted from administrative sources and caregiver questionnaires on admission through 30 days postdischarge. Medical home experience was assessed by using Maternal and Child Health Bureau definitions. Primary outcomes were 30-day unplanned readmission and 7-day ED visits to any hospital. Logistic regression explored relationships between outcomes and medical home experiences.
  
  
  RESULTS
  We followed 701 patients, 97% with complete data. Thirty-day unplanned readmission and 7-day ED revisit rates were 12.4% and 5.6%, respectively. More than 65% did not have a medical home. In adjusted models, those with medical home component "having a usual source of sick and well care" had fewer readmissions than those without (adjusted odds ratio 0.54, 95% confidence interval 0.30-0.96). Readmissions were higher among those with less parent confidence in avoiding a readmission, subspecialist primary care providers, longer length of index stay, and more hospitalizations in the past year. ED visits were associated with lack of parent confidence but not medical home components.
  
  
  CONCLUSIONS
  Lacking a usual source for care was associated with readmissions. Lack of parent confidence was associated with readmissions and ED visits. This information may be used to target interventions or identify high-risk patients before discharge.
authors.affiliation: Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; rcoller@pediatrics.wisc.edu.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Coller
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine at UCLA.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Klitzner
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine at UCLA.
authors.forename: Adrianna A
authors.initials: AA
authors.lastname: Saenz
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine at UCLA.
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Lerner
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine at UCLA, Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, and.
authors.forename: Bergen B
authors.initials: BB
authors.lastname: Nelson
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine at UCLA, Children's Discovery and Innovation Institute, Mattel Children's Hospital UCLA, and Department of Health Policy and Management, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California; and RAND Health, The RAND Corporation, Santa Monica, California.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D010290:Parents / Q000523:psychology; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014481:United States