Association of Early Primary Care Follow-Up With Acute Care Use After ICU Discharge

OBJECTIVE: To determine if early primary care follow-up after pediatric intensive care unit (PICU) hospitalization is associated with reduced acute care use. METHODS: Using claims data from publicly and privately insured children, we identified a cohort of PICU hospitalizations from January 2016 to December 2019. We matched children with and without early primary care follow-up (within 7 days of hospital discharge) 1 to 1 on demographic and clinical characteristics. We compared the number of days of acute care use (emergency department or rehospitalization) during days 8 to 90 postdischarge using negative binomial regression and reported incidence rate ratios (IRR). RESULTS: The sample included 180 516 PICU hospitalizations, including 158 544 for publicly insured children and 21 972 for privately insured children. Among PICU hospitalizations for publicly and privately insured children, 56 247 (35.4%) and 5156 (23.5%) were associated with acute care use with 8 to 90 days postdischarge. Hospitalizations of children with early primary care follow-up were less likely to be associated with acute care use than those without follow-up (public insurance: IRR, 0.93; 95% CI, 0.90-0.96; P < .001; and private insurance: IRR, 0.70; 95% CI, 0.63-0.77; P < .001). Subgroup analyses suggested early primary care follow-up was associated with larger decreases in acute care after hospitalizations of older children and children with sepsis. The association between early primary care follow-up and acute care use persisted in a secondary analysis using data from 2022 to 2023. CONCLUSIONS: Early primary care follow-up was associated with lower acute care use after discharge from PICU hospitalization. Promotion of early primary care follow-up may be warranted after pediatric critical illness.