What is this research about?

When a child is ready to be sent home from the hospital, doctors routinely tell parents to schedule a follow-up visit with their child’s primary care doctor within one week, even if their child’s symptoms continue to improve or resolve. This is called automatic follow-up. Unfortunately, follow-up visits can be a large burden for families. Often, parents have already taken time away from work and other responsibilities while their child is hospitalized. Attending a follow-up visit can mean more missed work for parents, missed school for the child, and increased costs from copays and travel to the visit. The time and financial sacrifices to attend a clinic visit are most challenging for racial/ethnic minority and lower-income families. These burdens can intensify what is already a stressful and anxious period for families.

As-needed follow-up is an alternative to automatic follow-up. Under this option, parents are told that they are not required to take their child to a follow-up visit if their child continues to improve at home. However, parents are also instructed that if their child does not improve or worsens, they should take their child for a follow-up visit. Many children who are being sent home from the hospital improve quickly at home. This makes as-needed follow-up an appealing option.    

The project team recently performed a study comparing automatic and as-needed follow-up for children hospitalized with a common respiratory infection called bronchiolitis. The team found that families who were given instructions to follow up as needed with their primary care provider chose to attend a visit 20 percent of the time, whereas families who were given instructions for automatic follow-up attended visits 80 percent of the time. In addition to spending less time and effort going to follow-up appointments, families in the as-needed follow-up group experienced similar satisfaction with their care, similar reductions in anxiety, and similar risk of rehospitalization.

What is the research team doing?

The team will perform a research study that compares automatic and as-needed follow-up for children who are hospitalized with other common infections, including pneumonia, diarrhea, urinary tract infection, and skin infection. The purpose of this study is to compare the effectiveness of automatic and as-needed follow-up for outcomes that are important to families and their medical providers. Patients will be recruited from 10 hospitals across the country. All study outcomes will be measured by parent report. The primary outcome that the team will study is a child’s risk of having to be rehospitalized after they have been sent home. Secondary outcomes will include: other healthcare outcomes (e.g., emergency department and clinic visits), patient- and family-centered outcomes (e.g., child missed school, parent missed work, and child quality of life), and overtreatment outcomes (e.g., new medication prescriptions and testing). Each of these outcomes will be measured within the first month after children are sent home from the hospital. The team will also measure continuity of care outcomes (e.g., parent relationship with primary care doctor and child being up to date on immunizations) up to six months after a child is sent home from the hospital. The team has partnered with parents, medical providers, hospital administrators, policy makers, and health insurance providers to make sure that every aspect of this project is guided by stakeholders for whom hospital follow-up is most important.   

Who can this research help?

Findings from this study will help families and medical providers make decisions about follow-up visits that are in the best interests of the child and their family. Families will likely be able to attend fewer clinic visits during the stressful time after their child is hospitalized. This benefits families by saving them time and money and benefits the healthcare system by freeing up valuable resources.