PRIMARY-CARE INVOLVEMENT AMONG HOSPITALIZED CHILDREN

Objective: To examine relations between characteristics of a child's u sual source of primary care and involvement of that source before and during hospitalization. Design: Medical record review of pediatric hos pitalizations. Setting: All hospitals in Boston, Mass; New Haven, Conn ; and Rochester, NY admitting children during the calendar years 1988 through 1990. Patients: The study included 1875 randomly selected pedi atric hospitalizations for five diagnostic groups tie, asthma and othe r lower respiratory tract disease, abdominal pain [including appendici tis], meningitis [bacterial and viral], toxic ingestions, and head inj ury). Hospital records selected were limited to children aged between 1 month and 12 years and residing in the three study communities. Outc ome Measures: Whether the primary care source examined the child befor e admission to the hospital, referred the child to the emergency depar tment, or served as the in-hospital attending physician. Results: Of t he medical charts reviewed, 85.7% identified primary care sources. Chi ldren in Rochester had higher rates of medical visits before admission (P<.04), referrals (P<.001), and in-hospital care provided by the pri mary care physician (P<.001, chi(2)) than children in Boston and New H aven. Patterns of primary care involvement also varied by source of ca re within cities, after controlling for income and severity of illness . Compared with children from Rochester community-based private practi ces, children in Boston receiving care from health centers, hospitals, or community-based private practices generally had 25% to 50% lower l ikelihood of positive findings on all primary care involvement measure s. Children in New Haven receiving care from community-based private o r hospital-based practices also had lower rates, but involvement rates were not higher when they received care from health centers. Other ch ildren in Rochester and children receiving care from health maintenanc e organizations in all cities demonstrated almost no significant diffe rences compared with data from Rochester community practices. Conclusi on: The source of primary care is associated with patterns of prehospi tal and hospital care among hospitalized children, although specific a ssociations vary by city.