Outpatient Follow-Up and Future Care-Seeking for Pediatric Ambulatory Care-Sensitive Conditions

Objective: Outpatient follow-up visits are often recommended for children with ambulatory care-sensitive conditions (ACSCs) who are discharged from emergency departments or urgent care centers (acute care settings). We sought to assess whether attending a follow-up visit within 7 days is associated with seeking initial office-based care rather than acute care during a subsequent ACSC illness. Understanding this association is crucial to guide recommendations for routine short-term follow-up visits in children who seek acute care for these common conditions. Methods: This was a cohort study of Medicaid-insured children younger than 18 years diagnosed with ACSCs and discharged from acute care settings in a multistate claims database in 2017–19. We used generalized estimating equations to assess the association between a follow-up visit within 7 days and the site of initial care (office vs acute care) during a subsequent ACSC illness. Models were adjusted for demographics, clinical characteristics, and prior patterns of health care utilization. Results: Among 866,392 acute care visits for ACSCs, 250,578 (28.9%) had an outpatient follow-up visit within 7 days. Follow-up was independently associated with increased odds of initial office-based care rather than initial acute care during the subsequent ACSC illness (adjusted odds ratio, 1.41, 95% confidence interval, 1.39–1.42). Conclusions: Outpatient follow-up after acute care visits for ACSCs was associated with increased odds of initial office-based care during the next illness episode. This association may support recommendations for follow-up visits for certain children to promote subsequent utilization of office-based settings during acute illnesses.