Young children who miss well-child visits are more likely to be hospitalized

Missing visits even worse for children with chronic health conditions

Seattle, WA—Young children who missed more than half of recommended well-child visits had up to twice the risk of hospitalization as children who attended most of their visits, according to a study published today in the American Journal of Managed Care. The study included more than 20,000 children enrolled at Group Health Cooperative.

Children with chronic conditions like asthma and heart disease were even more likely to be hospitalized when they missed visits, according to the study. In fact, children with chronic conditions who missed more than half of the recommended well-child visits had more than three times the risk of being hospitalized compared to children with chronic conditions who attended most of their visits. 

“Well-child visits are important because this is where children receive preventive immunizations and develop a relationship with their provider,” said lead author Jeffrey Tom, MD, MS, an assistant investigator with the Kaiser Permanente Center for Health Research in Hawaii. “These visits allow providers to identify health problems early and help to manage those problems so the children are less likely to end up in the hospital.”

When he conducted the study, Dr. Tom was a senior fellow in the University of Washington Department of Pediatrics.

“Regular preventive care for children with special needs and chronic conditions is even more important, given the risk of possible complications for their conditions, often leading to hospitalizations,” added coauthor David C. Grossman, MD, MPH, a senior investigator at Group Health Research Institute in Seattle. Dr. Grossman is also a Group Health pediatrician and Group Health’s medical director for population and purchaser strategy, and he has joint appointments at the University of Washington Schools of Medicine and Public Health.

The study included 20,065 children who were enrolled in Group Health from 1999 to 2006. Researchers followed the children from birth until age 3.5 years or until their first hospital stay, whichever came first.

During the study period, Group Health recommended nine well-child visits between birth and 3.5 years. The visits start at 3–5 days and continue at 1, 2, 4, 6, 10, and 15 months, and at 2 and 3.5 years.

Most children in the study (76 percent) attended at least three-quarters of the recommended visits, for which Group Health required no copayment. The authors say the lack of copayment is an important incentive and likely one reason for such good adherence to visits among the study population.

Overall, 4 percent of children in the study—and 9 percent of children with chronic conditions—were hospitalized. The two most common reasons for hospitalization in both groups were pneumonia and asthma.

Children who missed more than half of their visits had 1.4 to 2.0 times the risk of hospitalization compared to those who attended most of their visits. Children with chronic conditions who missed more than half of their visits had 1.9 to 3.2 times the risk of hospitalization compared to those who attended most of their visits.

Authors caution that their findings might not apply to all health systems because the study was conducted in an integrated health care system where the majority of children attend most of their well-child visits and tend to have families with higher-than-average income and education. The authors could not adjust for income, education, race, or ethnicity.

This study does not prove that missing well-child visits will increase the chance of hospitalization, although it does show an important association between these factors. The authors say one important reason for this link is that well-child visits allow for preventive care that keeps children from ending up in the hospital. An alternative explanation is that parents who miss well-child visits are also less likely to manage their kids’ illnesses and follow treatment regimens, which could result in higher rates of hospitalization for the children.

Some prior studies have found an association between missing well-child visits and increased hospitalization, but others reported no link. The authors of this study conducted an earlier study with similar findings in a fee-for-service medical setting in Hawaii, published in the Archives of Pediatrics and Adolescent Medicine (now JAMA Pediatrics) in November 2010.

Drs. Tom and Grossman’s coauthors were Rita Mangione‑Smith, MD, MPH, at the University of Washington and Seattle Children’s Research Institute; Cam Solomon, PhD, at Seattle Children’s Research Institute; and Chien‑Wen Tseng, MD, MPH, at the University of Hawaii and Pacific Health Research and Education Institute in Hawaii.

This study was supported by the Health Resources and Services Administration (grant T32HP10002-21), an agency of the U.S. Department of Health and Human Services—and by Group Health Cooperative and Group Health Research Institute.

Kaiser Permanente Center for Health Research

The Kaiser Permanente Center for Health Research, founded in 1964, is a nonprofit research institution dedicated to advancing knowledge to improve health. It has research sites in Portland, Ore., Honolulu and Atlanta.

UW Medicine

The UW Medicine health system includes Harborview Medical Center, Northwest Hospital & Medical Center, Valley Medical Center, UW Medical Center, UW Neighborhood Clinics, UW Physicians, UW School of Medicine and Airlift Northwest.  UW Medicine also shares in the ownership and governance of Children’s University Medical Group and Seattle Cancer Care Alliance, a partnership among UW Medicine, Fred Hutchinson Cancer Research Center and Seattle Children’s. UW Medicine has major academic and service affiliations with Seattle Children’s, Fred Hutchinson Cancer Research Center, the Veteran’s Affairs Puget Sound Health Care System in Seattle, and the VA Hospital in Boise, Idaho. The UW School of Medicine is the top public institution for biomedical research in funding received from the National Institutes of Health.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 12.4 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.