.jpeg.jpg "Jonathan Pelletier, MD photo")
Jonathan Pelletier, MD
Clinical Instructor
Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
Disclosure information not submitted.
Alicia Au, MD
Assistant Professor, Critical Care Medicine. Associate Medical Director, PICU
Children's Hospital of Pittsburgh of UPMC, United States
Disclosure information not submitted.
Dana Fuhrman, DO, MS
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Disclosure information not submitted.
Robert Clark, MD, FCCM
Professor of Critical Care Medicine and Pediatrics
Childrens Hospital of Pittsburgh of UPMC, United States
Disclosure information not submitted.
Christopher Horvat, MD, MHA
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania
Disclosure information not submitted.
Title: Association Between Healthcare Utilization After Bronchiolitis Admission and Future Hospitalization
Introduction: Little is known about outpatient healthcare utilization following hospitalization for bronchiolitis, and association between outpatient healthcare use and future readmissions. We conducted an electronic health record (EHR) linkage study to characterize the burden of healthcare utilization after discharge for viral bronchiolitis.
Methods: We performed a retrospective cohort analysis of children < 2 years old with a diagnosis of bronchiolitis between 1/1/2010 and 12/31/2019 with at least 1 year of primary care follow up within a single healthcare system. Demographic, vital sign, and laboratory data were extracted from the inpatient encounter. A healthcare system-wide query was performed for all inpatient and outpatient encounters with a physician or advanced practice provider between 1/1/2010 and 12/31/2020. Outpatient healthcare utilization and readmissions were summarized over time. Patients were stratified according to quartiles of outpatient visits in the 4 months following discharge from hospitalization. Readmission risk was analyzed by quartile.
RESULTS There were 1,437 patients in the cohort. Outpatient visits increased for approximately four months following bronchiolitis hospitalization (median [interquartile range [IQR] 4 [2-6] visits within 4 months of discharge) compared to previously reported age-matched controls. ICU admission and invasive mechanical ventilation were associated with subsequent outpatient visits. Patients in the highest quartile of outpatient utilization had four-fold more visits than those in the lowest quartile within 4 months of discharge (median [IQR] 8 [6-10] versus 4 2 [1-2] visits, p < 0.001). Patients in the highest quartile were more likely to be readmitted for any cause (50% in quartile 4 [Q4] versus 26% in quartile 1 [Q1], p < 0.001), more likely to be readmitted at least one year later (26% in Q4 versus 11% in Q1, p < 0.001), and more likely to have subsequent admissions for asthma (8.6% in Q1 versus 15% in Q4, p = 0.002) and pneumonia (6.1% in Q1 versus 17% in Q4, p < 0.001).
Conclusions: Outpatient healthcare utilization is increased for approximately 4 months following hospitalization for bronchiolitis. The degree of outpatient healthcare utilization may be useful in predicting future admissions for asthma and pneumonia.