Receipt, disparities, and impact of early primary care follow-up after pediatric critical illness

Project start date and end date: 7/1/2023 - Present

Background:
Each year in the US, nearly 170,000 children survive critical illness but often face physical, emotional, and cognitive morbidity following Pediatric Intensive Care Unit (PICU) hospitalization.  Despite a rising awareness that longitudinal evaluation and support may improve post-PICU outcomes, both current and optimal practice for follow-up after PICU are unclear. Early post-hospital primary care follow-up provides a key opportunity to evaluate for and address new and ongoing health problems, support continued growth and development, and assist in the transition back to home and school. As preventative care is a core tenant of pediatric medicine, some may assume that all children receive timely follow-up after hospitalization, especially after a PICU stay. However, prior studies show this is not the case. Thus, there is an urgent need for better data to guide the timing of follow-up after PICU hospitalization discharge.

Objective:

Aim 1:  To quantify receipt of early follow-up after PICU hospitalization discharge, and test for variation in the receipt of early post-PICU follow-up across patient subgroups.

Aim 2: To measure the association between early post-PICU follow-up and acute care utilization among PICU survivors using a target trial emulation framework.

Research Methods:
Using national multi-payer data (commercial insurance & Medicaid), we will measure receipt of early (within 7 days) primary care follow-up after PICU hospitalization and assess for disparities across patient age, comorbidity status, and socioeconomic status. Secondly, we will test whether receipt of post-PICU follow-up is associated with reduced 90-day acute care health care utilization (hospital readmission and emergency department use) using a “target trial emulation”. Target trial emulation incorporates features of a randomized control trial to provide the best possible causal inference from observational data.

Implications:
Our findings will provide needed data about whether early post-PICU follow-up should be standard of care and identify patient groups for whom early follow-up lags. This work will serve as the foundation for future studies to optimize post-hospital care of children who survive PICU hospitalization.

Funder:
Agency for Healthcare Quality and Research