Can primary care and continuity of care prevent asthma- related emergency department use and hospitalizations amongst children?
Bibliographic record
Abstract
Objective Having a primary care provider and a consistent, continuous relationship with said provider may be important for asthma outcomes. In Québec, children are mainly followed by family physicians in family medicine groups (FMGs), family physicians not part of FMGs, or by pediatricians. We sought to determine 1) whether having a usual provider of primary care was associated with asthma-related emergency department (ED) visits and hospitalization in Québec children with asthma and 2) whether continuity of care with a primary care provider was associated with acute asthma outcomes. Methods This was a population-based retrospective cohort study that used Québec provincial health administrative data from 2010-2013. The population was children diagnosed with asthma, aged 2-16 years old (N=39, 341). The main exposure was the primary care model (FMGs, non-FMGs, or pediatricians, compared to no assigned usual provider of care (UPC)). For those with an assigned UPC, continuity of care was measured by the UPC Index (high, medium, low). The main and secondary outcomes were asthma-related ED visits and hospitalizations, respectively. Multivariate logistic regression analyses were used to test associations between exposures and outcomes.ResultsOverall, 17.4% of children diagnosed with asthma in Québec had no assigned UPC. Compared to no assigned UPC, having a UPC was associated with decreased asthma-related ED visits (Pediatrician Odds Ratio (OR): 0.80, 95% confidence interval (CI) [0.73, 0.89], FMGs OR: 0.84, 95% CI [0.75,0.93], non-FMGs OR: 0.92, 95% CI [0.83, 1.02]) and hospital admissions (Pediatrician OR: 0.67, 95% CI [0.59, 0.76], FMGs OR: 0.83, 95% CI [0.73, 0.94], non-FMGs OR: 0.77, 95% CI [0.67, 0.87]). Children followed by a pediatrician were more likely to have high continuity of care. Continuity of care was not significantly associated with asthma-related ED visits but compared to low continuity, medium or high continuity was associated with decreased asthma-related hospital admissions (Medium OR: 0.81, 95% CI [0.73, 0.90], High OR: 0.72, 95% CI [0.63, 0.82])ConclusionHaving a usual provider of primary care was associated with reduced asthma-related ED visits and hospital admissions. For those who had a UPC, high continuity of care was associated with reduced likelihood of asthma-related hospital admissions.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".