A Mixed Methods Analysis of the Place-Related Risk and Protective Factors for Hospital Admissions and Emergency Department Visits among Children with Complex Chronic Conditions

Purpose: Children with complex chronic conditions (CCC) have high health care needs and utilization. The purpose of this study was to identify place-related risk and protective factors associated with hospital utilization among children with CCC. Methods: A mixed methods study was conducted to generate a risk profile of place-related factors associated with hospital utilization. The quantitative phase of the study consisted of retrospective review of 216 urban hospital medical records of infants and young children with CCC. The qualitative phase of the study included interviews with parents/caregivers and focus groups with health care providers (HCPs) of children with CCC. Results from multiple regression modeling and directed content analysis were merged using a side-by-side table organized by ecological level. Findings: Place-related risk and protective factors on multiple ecological levels were identified. Key place-related factors associated with hospital utilization were more complex conditions, positive relationships with HCPs, more parent/family resources, and having fewer place-related resources. Conclusions: The results of this study suggest patterns of health care utilization among infants and young children with CCC are influenced by place-related factors. Parent relationships with HCPs and comfort with care, hospital resources, and parent resources determine location of care. Results of this study also imply place-related disparities in access to care, especially among children in smaller metropolitan areas and rural-dwelling children. DOI: http://dx.doi.org/ 10.14574/ojrnhc.v15i2.364 Keywords: Rural population, Rural health services, Infant, Child, Preschool, Chronic disease