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Better education for children and parents could eliminate the need for many pediatric hospitalizations

Many pediatric hospitalizations might be avoided if parents and children were better educated about the child's condition, medications, need for followup care, and the importance of avoiding known disease triggers, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS11305). Avoidable hospitalization conditions (AHCs) are hospitalizations that usually can be avoided with timely, effective outpatient care. These range from acute illnesses such as urinary tract infections to chronic diseases such as asthma.

A research team led by Glenn Flores, M.D., of Boston Medical Center, conducted a cross-sectional survey of parents, primary care physicians (PCPs), and inpatient attending physicians (IAPs) for 554 children who were admitted with AHCs to an urban hospital during a 14-month period. Most of the children were poor and members of a minority race and had public health insurance.

The most frequent AHC diagnoses were asthma (43 percent), dehydration/gastroenteritis (16 percent), pneumonia (11 percent), seizure disorder (8 percent), and skin infections (8 percent). Only 25 percent of parents said that their child's admission was avoidable, compared with 29 percent of PCPs and 32 percent of IAPs. All three sources agreed that 13 percent of hospitalizations could have been avoided.

PCPs (71 percent) and IAPs (48 percent) cited parent/patient-related reasons for how hospitalizations could have been avoided significantly more often than parents (35 percent). These included adhering to and refilling medications, better outpatient followup, and avoiding known disease triggers. Parents (48 percent) significantly more often than PCPs (18 percent) and IAPs (37 percent) cited physician-related reasons for how hospitalizations could have been avoided. These included better education by physicians about the child's condition and better quality of care.

See "Keeping children out of hospitals: Parents' and physicians' perspectives on how pediatric hospitalizations for ambulatory care-sensitive conditions can be avoided," by Dr. Flores, Milagros Abreu, M.D., Christine E. Chaisson, M.P.H., and Donglin Sun, M.S., in the November 2003 Pediatrics 112(5), pp. 1021-1030.

Editor's Note: Two additional AHRQ-funded studies on related topics examine parental compliance with after hours telephone triage advice and the opportunity to encourage parents to stop smoking during a child's clinic visit. For details, see Lee, T.J., Baraff, L.J., Wall, S.P., and others (2003, September). "Parental compliance with after hours telephone triage advice: Nurse advice service versus on-call pediatricians." (AHRQ grant HS10604). Clinical Pediatrics 42, pp. 613-619; and Winickoff, J.P., Buckley, V.J., Palfrey, J.S., and others (2003, November). "Intervention with parental smokers in an outpatient pediatric clinic using counseling and nicotine replacement." (AHRQ training grant T32 HS00063). Pediatrics 112(5), pp. 1127-1133.

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