Seeing a child in primary care within a week of intensive care was linked to fewer return visits

Design

Matched retrospective cohort using US claims data

Population

180,516 paediatric intensive care hospitalisations (158,544 public and 21,972 private insurance), 2016 to 2019

Primary outcome

Days of emergency department use or rehospitalisation from day 8 to day 90

Effect

IRR 0.93 (95% CI 0.90 to 0.96) public; 0.70 (95% CI 0.63 to 0.77) private

Using US claims data for publicly and privately insured children, researchers identified 180,516 paediatric intensive care hospitalisations between 2016 and 2019. They matched children who had a primary care visit within 7 days of discharge with children who did not, 1 to 1 on demographic and clinical characteristics, and counted days of emergency department use or rehospitalisation from day 8 to day 90.

Acute care use occurred after 35.4% of publicly insured and 23.5% of privately insured hospitalisations. Early follow-up was associated with lower use: incidence rate ratio 0.93 (95% CI 0.90 to 0.96) with public insurance and 0.70 (95% CI 0.63 to 0.77) with private insurance. The association appeared larger after hospitalisation of older children and children with sepsis, and persisted in a secondary analysis of 2022 to 2023 data.

The design is observational: children who attend early may be better supported or less sick, which matching does not fully remove. It supports arranging a review within a week for children leaving intensive care, particularly where the family has few resources, but it does not prove the review prevents the return visits.

• Acute care use in days 8 to 90 followed 35.4% (public) and 23.5% (private) of intensive care stays.
• Early follow-up was associated with an incidence rate ratio of 0.93 (public) and 0.70 (private).
• The association was larger for older children and for sepsis.
• Consider booking a primary care review within 7 days before a child leaves intensive care.
• This is an association, and families who attend early may differ in ways the matching missed.

Why it matters

It suggests a low-cost step after critical illness may reduce further acute care use.

Don't overread it

Claims-based matched cohorts cannot show that the visit itself prevented the return visits.

The statistics, in plain English

An incidence rate ratio of 0.93 means about 7% fewer days of emergency visits or readmission in the early follow-up group; 0.70 means 30% fewer. The privately insured result is larger but based on far fewer children, and matching cannot account for unmeasured differences such as family support.

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