Primary care involvement among hospitalized children
J. M. Perrin, P. Greenspan, S. R. Bloom, D. Finkelstein, S. Yazdgerdi, J. M. Leventhal, L. Rodewald, P. Szilagyi and C. J. Homer
Children's Service, Massachusetts General Hospital, Boston, USA.
OBJECTIVE: To examine relations between characteristics of a child's usual
source of primary care and involvement of that source before and during
hospitalization. DESIGN: Medical record review of pediatric
hospitalizations. SETTING: All hospitals in Boston, Mass; New Haven, Conn;
and Rochester, NY admitting children during the calendar years 1988 through
1990. PATIENTS: The study included 1875 randomly selected pediatric
hospitalizations for five diagnostic groups (i.e., asthma and other lower
respiratory tract disease, abdominal pain [including appendicitis],
meningitis [bacterial and viral], toxic ingestions, and head injury).
Hospital records selected were limited to children aged between 1 month and
12 years and residing in the three study communities. OUTCOME MEASURES:
Whether the primary care source examined the child before admission to the
hospital, referred the child to the emergency department, or served as the
in-hospital attending physician. RESULTS: Of the medical charts reviewed,
85.7% identified primary care sources. Children in Rochester had higher
rates of medical visits before admission (P < .04), referrals (P <
.001), and in-hospital care provided by the primary care physician (P <
.001, chi 2) than children in Boston and New Haven. Patterns of primary
care involvement also varied by source of care within cities, after
controlling for income and severity of illness. Compared with children from
Rochester community-based private practices, children in Boston receiving
care from health centers, hospitals, or community-based private practices
generally had 25% to 50% lower likelihood of positive findings on all
primary care involvement measures. Children in New Haven receiving care
from community-based private or hospital-based practices also had lower
rates, but involvement rates were not higher when they received care from
health centers. Other children in Rochester and children receiving care
from health maintenance organizations in all cities demonstrated almost no
significant differences compared with data from Rochester community
practices. CONCLUSION: The source of primary care is associated with
patterns of prehospital and hospital care among hospitalized children,
although specific associations vary by city.
