Conclusions
The majority of published literature on hospital read- missions and repeat ED visits among CMC has focused on describing characteristics associated with frequent read- missions or repeat ED visits. One major gap in the literature is that few of the studies were conducted solely with samples of CMC; the majority included well children and CSHCN. Another gap in the literature was the small number of studies conducted in either rural or community-based settings; most study settings were ทานIticenter or freestanding children's hospitals. These gaps arc important because CMC are a unique population with needs beyond those of well children and CSHCN, and because an understanding of factors associated with hospital readmissions and repeat ED visits in rural or community-based settings could contribute to a more comprehensive understanding of the problem.
Further studies focusing solely on hospital readmissions and repeat ED visits among CMC must be conducted since this population has distinct, high-level needs. In every case, future research should be based on clearly defined measures of hospital readmissions and ED visits, and the CMC population should be identified using consistent terms and an unambiguous definition. Consideration should be made to the time frame used to define readmissions in ftiturc studies. Periods longer than die 30-day window considered by CMS may be necessary to accurately capture readmissions. Further studies should also be conducted that examine hospital readmissions and repeat ED visits in rural-dwelling CMC, sincc geographical location may influence health care utilization. Additional research investigating methods for reducing preventable readmissions or ED visits may also be nccessary. Care coordination has been specified as one strategy for addressing high health care utilization rates. A review of studies examining the role of care coordination in hospital readmissions and ED visits among CMC would be a beneficial addition to the literature in this area. Gaps that may be identified through such a literature review could delineate further avenues for future inquiry.
Beyond research, findings of the review have implications for nursing practice. Nurses must be aware of the heightened national focus on addressing preventable hospital read- missions and should be active participants in creating and implementing interventions attending to the issue. In both the primary and acute care settings, nurses can develop educational plans with CMC and their families that are tailored toward reducing the risk of readmissions or repeat ED visits. Primary care and acute care nurses may also consider seeking care coordination services (such as a health care/medical home) tor CMC as a strategy for reducing readmissions and repeat ED visits. Since characteristics of CSHCN and CMC with high readmission and repeat ED visit rates have been identified, nurses should be aware of increased risV for thtf characteristics. Additionally, community-based nurses should be particularly aware of these characteristics and should consider efforts to improve community resources among CMC, particularly for those children with multiple risk factors for increased readmissions and ED visits. Greater knowledge of the ECCM in nursing practice could also be of benefit as this model outlines how the health care system can work with communities to promote wellness in chronically ill populations. Awareness and action toward strengthening the relationship between patients and the health care team could lead to improved health outcomes; in particular, action should be focused on assessing community-based needs and strengthening community resources.
Acknowledgments
The author wishes to thank Dr. Marilyn Laken, Dr. Gayenell Magwood, Dr. Martina Mueller, and Dr. Lisa Kerr for their assistance in the preparation of this manuscript. No extramural funding. No previous presentations. No commercial financial support.