Reminders to parents could lower kids' hospital admissions

Researchers recommend greater attention to follow-up visits as one way to avoid some expensive and disruptive pediatric hospitalizations.

By Susan J. Landers, amednews staff. Nov. 24, 2003.

Washington -- More time spent by physicians educating the parents of young patients about managing their children's health problems at home could greatly reduce the number of pediatric hospital admissions that occur each year in the United States, according to a study in the November issue of Pediatrics.

Estimates of avoidable hospitalizations for conditions such as asthma or gastroenteritis ranged from 12% to 46% depending on whether parents, primary care or hospital-based physicians were doing the assessing and whether or not all three agreed.

Keeping them home
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Even a small decline in avoidable hospital stays could result in large savings for the nation's health care system as well as fewer disruptions in the lives of the children and their families.

"Hospitalizations account for about 58% of what we spend on children's health care each year," said study author Glenn Flores, MD, director of community outcomes in the Dept. of Pediatrics at the Medical College of Wisconsin in Madison.

About 6.5 million hospitalizations for children occur annually in the United States at a cost of about $50 billion, he said.

The study recommends actions that physicians and parents can take to whittle down those numbers.

Hospitalizations account for 58% of health care costs for children.

"Physicians sometimes don't take enough time to make sure that parents understand what they can do to prevent their children from being hospitalized," said Dr. Flores. "This may be due in part to increased time constraints placed on physicians by managed care."

"At the same time, parents need to be more assertive about making sure they understand what they need to do," he added.

The researchers surveyed parents, primary care physicians and inpatient attending physicians during a 14-month period regarding 554 children who were admitted to Boston Medical Center with conditions that are often managed in the offices of primary care physicians.

The diagnoses included asthma, dehydration, gastroenteritis, pneumonia, seizure disorders and skin infections. Those conditions accounted for nearly 90% of avoidable hospitalizations among the children, according to the study.

Most of the children were from poor minority families and had either public health insurance or were without insurance. Avoidable hospitalizations were defined as inpatient stays for conditions that could have been prevented through immunizations or managed well and controlled in outpatient settings.

Differences of opinion

The researchers found substantial variation among the three parties queried as to whether a hospitalization was avoidable or not. In only 12% of cases did parents, primary care physicians and hospital physicians agree that a hospitalization was avoidable. In 46% of cases at least one party thought a hospital stay could have been avoided.

Adolescents, children with asthma, children from working poor families and those without health insurance were classified to be at greatest risk for hospitalizations.

Pediatric hospital admissions cost $50 billion a year.

More attention to follow-up visits by parents and physicians is one way to cut down on such occurrences, according to the researchers.

"We found it was a two-way street," said Dr. Flores. "Parents would forget when the follow-up was, and physicians admitted sometimes they didn't do a good job of making sure the parent attended to the follow-up."

The researchers suggest that physicians rely more on written or phone reminders. "I think I get a better reminder system for my two cats from the veterinarian than I do for my 5-year-old," said Dr. Flores.

Parents could also be better instructed on the use of medications and avoiding known disease triggers such as dust and pets for children with asthma.

Asthma was especially problematic and was the reason for 43% of the hospitalizations identified as avoidable. The number of children with the condition has doubled since 1980 to almost 4.4 million, with 174,000 children hospitalized annually for asthma.

A coordinated approach by inpatient and outpatient physicians in directing parents on how best to treat asthma in their children would be helpful, said Dr. Flores. More coordination between primary care doctors and hospital admitting physicians in general would be useful, he said.

The study also uncovered some finger-pointing and differences of opinion between inpatient physicians and outpatient physicians over the necessity of the hospitalizations. While primary care physicians said their hospital counterparts were responsible for inappropriate admissions in 5% of the cases, physicians doing the admitting said those admissions were inappropriate in only 0.5% of cases.

One message coming from the primary care physician was "Hey, what are these inpatient doctors doing admitting my kid? He didn't have to be admitted," Dr. Flores interprets.

Meanwhile, the message from the inpatient physicians seemed to be, "Maybe these primary care docs should do a little more in their offices to prevent problems downstream."

ADDITIONAL INFORMATION:

Keeping them home

A study in the November Pediatrics offered tips for physicians to better manage children's illnesses and avoid unnecessary hospital admissions:

Institute a system to ensure parents attend follow-up visits.
Rely more on written or telephone reminders to keep treatment plan on track.
Spend time instructing parents on children's medication, illness prevention strategies and avoidance of disease triggers.

Weblink

"Keeping Children Out of Hospitals: Parents' and Physicians' Perspectives on How Pediatric Hospitalizations for Ambulatory Care-Sensitive Conditions Can Be Avoided," abstract, Pediatrics, November (pediatrics.aappublications.org/cgi/content/abstract/112/5/1021)