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Harmon I, Brailsford J, Sanchez-Cano I, Fishe J. Development of a Computable Phenotype for Prehospital Pediatric Asthma Encounters. PREHOSP EMERG CARE 2024:1-12. [PMID: 38713633 DOI: 10.1080/10903127.2024.2352583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/29/2024] [Indexed: 05/09/2024]
Abstract
INTRODUCTION Asthma exacerbations are a common cause of pediatric Emergency Medical Services (EMS) encounters. Accordingly, prehospital management of pediatric asthma exacerbations has been designated an EMS research priority. However, accurate identification of pediatric asthma exacerbations from the prehospital record is nuanced and difficult due to the heterogeneity of asthma symptoms, especially in children. Therefore, this study's objective was to develop a prehospital-specific pediatric asthma computable phenotype (CP) that could accurately identify prehospital encounters for pediatric asthma exacerbations. METHODS This is a retrospective observational study of patient encounters for ages 2-18 years from the ESO Data Collaborative between 2018 and 2021. We modified two existing rule-based pediatric asthma CPs and created three new CPs (one rule-based and two machine learning-based). Two pediatric emergency medicine physicians independently reviewed encounters to assign labels of asthma exacerbation or not. Taking that labeled encounter data, a 50/50 train/test split was used to create training and test sets from the labeled data. A 90/10 split was used to create a small validation set from the training set. We used specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and macro F1 to compare performance across all CP models. RESULTS After applying the inclusion and exclusion criteria, 24,283 patient encounters remained. The machine-learning models exhibited the best performance for the identification of pediatric asthma exacerbations. A multi-layer perceptron-based model had the best performance in all metrics, with an F1 score of 0.95, specificity of 1.00, sensitivity of 0.91, negative predictive value of 0.98, and positive predictive value of 1.00. CONCLUSION We modified existing and developed new pediatric asthma CPs to retrospectively identify prehospital pediatric asthma exacerbation encounters. We found that machine learning-based models greatly outperformed rule-based models. Given the high performance of the machine-learning models, the development and application of machine learning-based CPs for other conditions and diseases could help accelerate EMS research and ultimately enhance clinical care by accurately identifying patients with conditions of interest.
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Affiliation(s)
- Ira Harmon
- Center for Data Solutions, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Jennifer Brailsford
- Center for Data Solutions, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Isabel Sanchez-Cano
- Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Jennifer Fishe
- Center for Data Solutions, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
- Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
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2
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Peters GA, Cash RE, Goldberg SA, Gao J, Kolb LM, Camargo CA. Patient-related Factors Associated with Potentially Unnecessary Transfers for Pediatric Patients with Asthma: A Retrospective Cohort Study. West J Emerg Med 2024; 25:407-414. [PMID: 38801048 PMCID: PMC11112663 DOI: 10.5811/westjem.18399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/08/2023] [Accepted: 12/28/2023] [Indexed: 05/29/2024] Open
Abstract
Background/Objective Asthma is a common chronic medical condition among children and the most common diagnosis associated with interfacility transports for pediatric patients. As many as 40% of pediatric transfers may be unnecessary, resulting in potential delays in care and unnecessary costs. Our objective was to identify the patient-related factors associated with potentially unnecessary transfers for pediatric patients with asthma. Methods We used patient care data from the California Department of Health Care Access and Information patient discharge and emergency department (ED) datasets to capture ED visits where a pediatric patient (age 2-17 years) presented with asthma and was transferred to another ED or acute care hospital. The outcome of interest was a potentially unnecessary transfer, defined as a visit where length of stay after transfer was <24 hours and no advanced services were used, such as respiratory therapy or critical care. Patient-related characteristics were extracted, including age, gender, race/ethnicity, primary language, insurance status, and clinical characteristics. First, we used descriptive statistics to compare necessary vs unnecessary transfers. Second, we used generalized estimating equations accounting for clustering by ED to estimate odds ratios (OR) and identify factors associated with potentially unnecessary transfers. Results A total of 4,233 pediatric ED patients were transferred with a diagnosis of asthma, including 461 (11%) transfers that met criteria as potentially unnecessary. Median age was 12 years (interquartile range 7-15), and 46% were female. Factors associated with increased odds of potentially unnecessary transfer while controlling for key factors included younger age (eg, 2-5 years, OR 2.0, 95% confidence interval [CI] 1.4-2.9), male gender (OR 1.4, 95% CI 1.1-1.7), and Hispanic ethnicity (OR 1.6, 95% CI 1.2-2.1), while multiple hospitalizations for asthma per year was associated with decreased odds (OR 0.2, 95% CI 0.1-0.4). Conclusion Several patient-related factors were associated with increased or decreased odds of potentially unnecessary transfers among pediatric patients presenting to the ED with asthma. These factors can be considered in future work to better understand, predict, and reduce unnecessary transfers and their negative consequences.
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Affiliation(s)
- Gregory A Peters
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Rebecca E Cash
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Scott A Goldberg
- Harvard Medical School, Boston, Massachusetts
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Jingya Gao
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Lily M Kolb
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Carlos A Camargo
- Harvard Medical School, Boston, Massachusetts
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, Massachusetts
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3
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Smith MA, Dinh D, Ly NP, Ward SL, McGarry ME, Zinter MS. Changes in the Use of Invasive and Noninvasive Mechanical Ventilation in Pediatric Asthma: 2009-2019. Ann Am Thorac Soc 2023; 20:245-253. [PMID: 36315585 PMCID: PMC9989865 DOI: 10.1513/annalsats.202205-461oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/31/2022] [Indexed: 02/04/2023] Open
Abstract
Rationale: Despite lower overall hospitalization rates for asthma in recent years, there has been an increase in the number of pediatric patients receiving intensive care management in the United States. Objectives: To investigate how the use of invasive and noninvasive mechanical ventilation for asthma has changed in the context of an evolving cohort of critically ill pediatric patients with asthma. Methods: We analyzed children admitted to intensive care units for asthma from 2009 through 2019 in the Virtual Pediatric Systems database. Regression analyses were used to evaluate how respiratory support interventions, mortality, and patient characteristics have changed over time. Odds ratios were calculated to determine how patient characteristics were associated with respiratory support needs. Stratified analyses were performed to determine how changing practice patterns may have differed between patient subgroups. Results: There were 67,614 admissions for 56,727 patients analyzed. Intubation occurred in 4.6% of admissions and decreased from 6.9% to 3.4% over time (P < 0.001), whereas noninvasive ventilation as the maximal respiratory support increased from 8.9% to 20.0% (P < 0.001). Over time, the cohort shifted to include more 2- to 6-year-olds and patients of Asian/Pacific Islander or Hispanic race/ethnicity. Although intubation decreased and noninvasive ventilation increased in all subgroups, the changes were most pronounced in the youngest patients and slightly less pronounced for obese patients. Conclusions: In pediatric asthma, use of intubation has halved, whereas use of noninvasive ventilation has more than doubled. This change in practice appears partially related to a younger patient cohort, although other factors merit exploration.
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Affiliation(s)
| | - Doantrang Dinh
- Division of Pulmonary Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Ngoc P. Ly
- Division of Pulmonology, Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California; and
| | | | - Meghan E. McGarry
- Division of Pulmonology, Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California; and
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Kamal A, Abdelmegeid AK, Gabr MAM, Basanti CWS. Serum decoy receptor 3 (DcR3): a promising biomarker for atopic asthma in children. Immunol Res 2021; 69:568-575. [PMID: 34383195 DOI: 10.1007/s12026-021-09218-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/23/2021] [Indexed: 11/24/2022]
Abstract
Bronchial asthma is a common chronic inflammatory disease with high prevalence and morbidity, particularly in school-aged children. Decoy receptor 3 (DcR3) is a soluble decoy receptor that belongs to the tumor necrosis factor receptor superfamily and has been reported to be elevated in several allergic and inflammatory diseases. This study was designed to determine the role of DcR3 in pediatric asthma. The serum DcR3 levels were analyzed in 85 subjects (60 pediatric patients with bronchial asthma and 25 age- and sex-matched healthy control children) using the enzyme-linked immunosorbent assay technique. Patients with asthma had higher serum DcR3 levels than healthy control subjects (p = 0.007). In the atopic group of patients with asthma, the serum DcR3 levels were inversely correlated with the asthma control test score (R = - 0.392, p = 0.039). Overall, DcR3 could be a promising biomarker of atopic asthma, specifically in pediatric patients.
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Affiliation(s)
- Asmaa Kamal
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Azza K Abdelmegeid
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Maha A M Gabr
- Department of Pediatrics, Kafr El Sheikh General Hospital, Kafr El Sheikh, Egypt
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Bruzzese JM, George M, Liu J, Evans D, Naar S, DeRosier ME, Thomas JM. The Development and Preliminary Impact of CAMP Air: A Web-based Asthma Intervention to Improve Asthma Among Adolescents. PATIENT EDUCATION AND COUNSELING 2021; 104:865-870. [PMID: 33004234 PMCID: PMC7956908 DOI: 10.1016/j.pec.2020.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Describe the development and preliminary impact of CAMP Air, a web-based intervention for adolescents with uncontrolled asthma. MATERIALS AND METHODS CAMP Air was developed using an iterative process with input from stakeholders and incorporating usability testing results (n = 14 adolescents). To test CAMP Air's initial impact, 61 adolescents from two New York City public high schools (n = 37) and from clinics, community-based organizations, and third-party recruitment services (i.e., community sample; n = 24) were enrolled in a randomized pilot trial. Participants were randomized to CAMP Air (n = 30) or information-and-referral control intervention (n = 31). A point-person worked with school participants to complete CAMP Air. RESULTS CAMP Air participants were satisfied with the intervention and its value for supporting self-management, completing on average 6 of 7 modules. Relative to controls, CAMP Air participants demonstrated significantly improved asthma knowledge, asthma control, night wakening and school absences, and less risk for urgent care visits. Adolescents enrolled in schools completed more modules and had significantly fewer nights woken and school absences than community enrollees. CONCLUSION CAMP Air improves asthma outcomes among adolescents with uncontrolled asthma. PRACTICE IMPLICATIONS A web-based intervention CAMP Air is a promising intervention. When a point-person works with adolescents, CAMP Air's access and impact are improved.
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Affiliation(s)
| | | | - Jianfang Liu
- Columbia University School of Nursing, United States
| | - David Evans
- Columbia University Mailman School of Public Health, United States
| | - Sylvie Naar
- Florida State University, Center for Translational Behavioral Science, United States
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6
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Asthma-Related Emergency Department Visits Among Low-Income Families With Young Children by Race/Ethnicity and Primary Language. Pediatr Emerg Care 2020; 36:e636-e640. [PMID: 30672895 DOI: 10.1097/pec.0000000000001430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to examine the existence of racial/ethnic and language disparities in asthma-related emergency department (ED) initial and return visits among young children in low-income families in California. METHODS Children younger than 6 years with at least 1 asthma-related ED visit recorded in the California Office of Statewide Health Planning and Development data set between January 1, 2009, and December 31, 2013, and on Medicaid (Medi-Cal) were assessed. Primary outcomes were hospitalization at the first asthma-related ED visit and a return asthma-related ED visit within 12 months. Data were analyzed using multivariate logistic regression. RESULTS Among 47,657 children, approximately 55% were Hispanic, 20% were black, and 2.7% were Asian/Pacific Islander. For non-English-speaking families, 82% were Hispanic. Among English-speaking families, blacks were less likely to be hospitalized at the first ED visit (odds ratio [OR], 0.787; 95% confidence interval [CI], 0.715-0.866) but more likely to return to the ED (OR, 1.291; 95% CI, 1.205-1.383) compared with whites. Conversely, Asian/Pacific Islanders whose primary language was English were more likely to be hospitalized (OR, 2.150; 95% CI, 1.827-2.530) compared with whites. Among families whose primary language was not English, Hispanic and Asian/Pacific Islanders are more likely to be hospitalized at the first ED visit and all groups are less likely to return to the ED compared with English-speaking whites. CONCLUSIONS The findings suggest that racial/ethnic and language disparities exist in eventual asthma-related hospitalizations and repeat ED visits. Continued research is needed to understand the existence of these differences and to inform future comprehensive and linguistically appropriate asthma interventions for children in low-income families.
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7
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Şekerel BE, Türktaş H, Bavbek S, Öksüz E, Malhan S. Economic Burden of Pediatric Asthma in Turkey: A Cost of Illness Study from Payer Perspective. Turk Thorac J 2020; 21:248-254. [PMID: 32687785 DOI: 10.5152/turkthoracj.2019.19025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 08/06/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To estimate economic burden of pediatric asthma in Turkey from payer perspective. MATERIALS AND METHODS This cost of illness study was based on identification of per patient annual direct medical costs for the management of pediatric asthma in Turkey from payer perspective. Average per patient direct medical cost was calculated based on cost items related to outpatient visits, laboratory and radiological tests, hospitalizations and interventions, drug treatment and equipment, and co-morbidities/complications. RESULTS Based on total annual per patient costs calculated for outpatient admission ($113.14), laboratory-radiological tests ($35.94), hospitalizations ($725.92), drug treatment/equipment ($212.90) and co-morbidities/complications ($144.62) cost items, total per patient annual direct medical cost related to management of pediatric asthma was calculated to be $1,232.53 from payer perspective. Hospitalizations and interventions (58.9%) was the main cost driver. Direct cost for managing controlled and uncontrolled pediatric asthma were calculated to be $530.17 [key cost driver: drugs/equipment (40.0%)] and $1,023.16 [key cost driver: hospitalization/interventions (59.0%)], respectively. CONCLUSION Our findings indicate that managing patients with pediatric asthma pose a considerable burden to health economics in Turkey, with hospitalizations identified as the main cost driver and two-fold cost increment in case of uncontrolled disease.
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Affiliation(s)
- Bülent Enis Şekerel
- Department of Pediatrics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Haluk Türktaş
- Department of Chest Diseases, Gazi University School of Medicine, Ankara, Turkey
| | - Sevim Bavbek
- Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Ergün Öksüz
- Department of Family Medicine, Başkent University School of Medicine, Ankara, Turkey
| | - Simten Malhan
- Department of Health Care Management, Başkent University Faculty of Health Sciences, Ankara, Turkey
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8
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Brooks JL, Asafu-Adjei J, Currin EG, Beeber LS. Exploring a broader context of the home environment and its relationship with asthma control in American Indian children. Res Nurs Health 2020; 43:218-229. [PMID: 32274808 DOI: 10.1002/nur.22020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/13/2020] [Accepted: 03/28/2020] [Indexed: 11/06/2022]
Abstract
In this cross-sectional study of 60 American Indian mother-child dyads from Southeastern North Carolina, we examined whether childhood asthma control was related to household-level factors, such as environmental tobacco smoke and family management behaviors. We also examined the relationships among family management behaviors and maternal depressive symptoms. We used logistic regression to assess the relationships among childhood asthma control, the presence of environmental tobacco smoke, and family management behaviors, specifically condition management ability (CMA) and condition management effort (CME). We used linear regression to evaluate the relationships between both CMA and CME and maternal depressive symptoms. Better asthma control in children was associated with the absence of environmental tobacco smoke in the home and the maternal perception of asthma as a manageable condition. Mothers perceived an increase in effort to manage their child's asthma as their depressive symptoms increased. These findings emphasize the importance of environmental triggers, perceptions of condition management, and maternal mental health in controlling asthma in American Indian children. Interventions to reduce environmental triggers, treat maternal depressive symptoms, and support mothers in their ability to manage childhood asthma may yield better asthma control and help to reduce existing racial disparities in this population.
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Affiliation(s)
- Jada L Brooks
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Josephine Asafu-Adjei
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily G Currin
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Linda S Beeber
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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9
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Cushing AM, Bucholz E, Michelson KA. Trends in Regionalization of Emergency Care for Common Pediatric Conditions. Pediatrics 2020; 145:peds.2019-2989. [PMID: 32169895 PMCID: PMC7236317 DOI: 10.1542/peds.2019-2989] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND For children who cannot be discharged from the emergency department, definitive care has become less frequent at most hospitals. It is uncertain whether this is true for common conditions that do not require specialty care. We sought to determine how the likelihood of definitive care has changed for 3 common pediatric conditions: asthma, croup, and gastroenteritis. METHODS We used the Nationwide Emergency Department Sample database to study children <18 years old presenting to emergency departments in the United States from 2008 to 2016 with a primary diagnosis of asthma, croup, or gastroenteritis, excluding critically ill patients. The primary outcome was referral rate: the number of patients transferred among all patients who could not be discharged. Analyses were stratified by quartile of annual pediatric volume. We used logistic regression to determine if changes over time in demographics or comorbidities could account for referral rate changes. RESULTS Referral rates increased for each condition in all volume quartiles. Referral rates were greatest in the lowest pediatric volume quartile. Referral rates in the lowest pediatric volume quartile increased for asthma (13.6% per year; 95% confidence interval [CI] 5.6%-22.2%), croup (14.8% per year; 95% CI 2.6%-28.3%), and gastroenteritis (16.4% per year; 95% CI 3.5%-31.0%). Changes over time in patient age, sex, comorbidities, weekend presentation, payer mix, urban-rural location of presentation, or area income did not account for these findings. CONCLUSIONS Increasing referral rates over time suggest decreasing provision of definitive care and regionalization of inpatient care for 3 common, generally straightforward conditions.
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Affiliation(s)
- Anna M Cushing
- Boston Children's Hospital, Boston, Massachusetts; and .,Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Emily Bucholz
- Boston Children's Hospital, Boston, Massachusetts; and
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10
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Pantell MS, Kaiser SV, Torres JM, Gottlieb LM, Adler NE. Associations Between Social Factor Documentation and Hospital Length of Stay and Readmission Among Children. Hosp Pediatr 2020; 10:12-19. [PMID: 31888952 DOI: 10.1542/hpeds.2019-0123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Social risk factors are linked to children's health, but little is known about how frequently these factors are documented using the International Classification of Diseases (ICD) or whether documentation is associated with health care use outcomes. Using a large administrative database of pediatric hospitalizations, we examined the prevalence of ICD social risk code documentation and hypothesized that social code documentation would be associated with longer length of stay (LOS) and readmission. METHODS We analyzed hospitalizations of children ages ≤18 using the 2012 Nationwide Readmissions Database. The following ICD social codes were used as predictors: family member with alcohol and/or drug problem, history of abuse, parental separation, foster care, educational circumstance, housing instability, other economic strain, and legal circumstance. Outcomes included long LOS (top quintile) and readmission within 30 days after discharge. Covariates included individual, hospital, and season variables. RESULTS Of 926 073 index hospitalizations, 7432 (0.8%) had International Classification of Diseases, Ninth Revision, social codes. Social code documentation was significantly associated with long LOS. Adjusting for covariates, family alcohol and/or drug problem (odds ratio [OR] 1.65; 95% confidence interval [CI] 1.16-2.35), foster care (OR 2.37, 95% CI 1.53-3.65), other economic strain (OR 2.12, 95% CI 1.38-3.26), and legal circumstances (OR 1.66; 95% CI 1.02-2.71) remained significant predictors of long LOS. Social code documentation was not associated with readmission after adjusting for covariates. CONCLUSIONS Social ICD codes are associated with prolonged LOS and readmission in pediatric hospitalizations, but they are infrequently documented. Future work exploring these associations could help to determine if addressing social risk factors in inpatient settings might improve child health outcomes.
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Affiliation(s)
- Matthew S Pantell
- Division of Hospital Medicine, Department of Pediatrics,
- Center for Health and Community, University of California, San Francisco, San Francisco, California
| | | | | | - Laura M Gottlieb
- Family and Community Medicine, and
- Center for Health and Community, University of California, San Francisco, San Francisco, California
| | - Nancy E Adler
- Psychiatry, and
- Center for Health and Community, University of California, San Francisco, San Francisco, California
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11
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Dunlop JH, Keet CA. Allergic diseases among Asian children in the United States. J Allergy Clin Immunol 2019; 144:1727-1729.e6. [DOI: 10.1016/j.jaci.2019.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/28/2019] [Accepted: 08/05/2019] [Indexed: 11/25/2022]
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12
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Sakai-Bizmark R, Chang RKR, Mena LA, Webber EJ, Marr EH, Kwong KY. Asthma Hospitalizations Among Homeless Children in New York State. Pediatrics 2019; 144:peds.2018-2769. [PMID: 31262776 PMCID: PMC6856786 DOI: 10.1542/peds.2018-2769] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Asthma is widely prevalent among US children, particularly in homeless children, who often lack proper medication storage or the ability to avoid environmental triggers. In this study, we assess asthma-attributed health care use among homeless youth. We hypothesize that asthma hospitalization rates, symptom severity, and admission through the emergency department (ED) will be higher among homeless youth compared with nonhomeless youth. METHODS This secondary data analysis identified homeless and nonhomeless pediatric patients (<18 years old) with a primary diagnosis of asthma from New York statewide inpatient databases between 2009 and 2014. Hospitalization rate, readmission rate, admission through the ED, ventilation use, ICU admittance, hospitalization cost, and length of stay were measured. RESULTS We identified 71 837 asthma hospitalizations, yielding 73.8 and 2.3 hospitalizations per 1000 homeless and nonhomeless children, respectively. Hospitalization rates varied by nonhomeless income quartile, with low-income children experiencing higher rates (5.4) of hospitalization. Readmissions accounted for 16.0% of homeless and 12.5% of nonhomeless hospitalizations. Compared with nonhomeless patients, homeless patients were more likely to be admitted from the ED (odds ratio 1.96; 95% confidence interval: 1.82-2.12; P < .01), and among patients >5 years old, homeless patients were more likely to receive ventilation (odds ratio 1.45; 95% confidence interval: 1.01-2.09; P = .04). No significant differences were observed in ICU admittance, cost, or length of stay. CONCLUSIONS Homeless youth experience an asthma hospitalization rate 31 times higher than nonhomeless youth, with higher rates of readmission. Homeless youth live under uniquely challenging circumstances. Tailored asthma control strategies and educational intervention could greatly reduce hospitalizations.
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Affiliation(s)
- Rie Sakai-Bizmark
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California; .,Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and
| | - Ruey-Kang R. Chang
- Los Angeles Biomedical Research Institute,
Harbor-UCLA Medical Center, Torrance, California;,Department of Pediatrics, David Geffen School of
Medicine, University of California, Los Angeles, Los Angeles, California;
and
| | - Laurie A. Mena
- Los Angeles Biomedical Research Institute,
Harbor-UCLA Medical Center, Torrance, California
| | - Eliza J. Webber
- Los Angeles Biomedical Research Institute,
Harbor-UCLA Medical Center, Torrance, California
| | - Emily H. Marr
- Los Angeles Biomedical Research Institute,
Harbor-UCLA Medical Center, Torrance, California
| | - Kenny Y. Kwong
- Division of Allergy-Immunology, Department of
Pediatrics, Los Angeles County and University of Southern California Medical
Center, Los Angeles, California
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13
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Whittle S, Lopez M, Russell H. Payer and race/ethnicity influence length and cost of childhood cancer hospitalizations. Pediatr Blood Cancer 2019; 66:e27739. [PMID: 30989762 PMCID: PMC7057732 DOI: 10.1002/pbc.27739] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/22/2019] [Accepted: 03/15/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Health disparities related to race, ethnicity, socioeconomic status, and insurance status impact quality, access, and health outcomes for children. Medicaid is a proxy for poverty and restricted access to health care. The goal of this study was to determine if there are discrepancies in the length and cost of hospitalizations between admissions covered by Medicaid or commercial insurance for pediatric patients with cancer. METHODS Childhood cancer-related admissions were identified from the 2012 Kids Inpatient Database (KID) using the International Classification of Diseases, Ninth revision. Length of hospitalization and cost of hospitalization were compared among hospitalizations paid by Medicaid or commercial insurance. Total admission charges were converted to costs using cost-to-charge ratios, and survey weighting methods were used for all analyses. Linear multiple regression models for both length of hospitalization and cost were developed to include patient-level factors (race, sex, age, diagnosis, reason for admission). RESULTS In 2012, there were 104 597 childhood cancer-related admissions. Hospitalizations paid by Medicaid were significantly longer than those paid by commercial insurance. Hispanic ethnicity was associated with higher cost of hospitalization regardless of payer, and black race was associated with higher costs within the Medicaid population. CONCLUSIONS This analysis identifies differences in healthcare utilization for pediatric cancer-related admissions paid for by Medicaid compared with commercial insurance. Prolonged hospitalizations and increased costs create burdens on children and their families, medical delivery systems, and third-party payers. Further exploration into the causes of these disparities is warranted.
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Affiliation(s)
- Sarah Whittle
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston TX,Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Michelle Lopez
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Heidi Russell
- Texas Children’s Cancer and Hematology Centers, Texas Children’s Hospital, Houston TX,Department of Pediatrics, Baylor College of Medicine, Houston, TX,Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
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Wen C, Liu SH, Li Y, Sheffield P, Liu B. Pediatric Asthma Among Small Racial/Ethnic Minority Groups: An Analysis of the 2006-2015 National Health Interview Survey. Public Health Rep 2019; 134:338-343. [PMID: 31120804 DOI: 10.1177/0033354919849943] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Few studies have examined the asthma burden among small racial/ethnic minority groups such as Asian children. We examined asthma disparities among children aged 4-17 in 6 small non-Hispanic racial/ethnic minority groups (American Indian/Alaska Native [AI/AN], Asian Indian, Chinese, Filipino, other Asian, and multiple race) by using the 2006-2015 National Health Interview Survey. These small minority groups represented a weighted 6.1% of the study population (6770 of 88 049). The prevalence of current asthma ranged from 5.5% (95% confidence interval [CI], 3.5%-7.5%) among Chinese children to 13.8% (95% CI, 10.4%-17.2%) among multiple-race children and 14.6% (95% CI, 10.8%-18.4%) among AI/AN children. Compared with non-Hispanic white children, AI/AN (adjusted odds ratio [aOR] = 1.6; 95% CI, 1.2-2.2) and multiple-race (aOR = 1.4; 95% CI, 1.0-2.0) children had higher odds for current asthma. Several small racial/ethnic minority groups are at heightened risk of asthma-associated outcomes, highlighting the need for further research on these populations.
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Affiliation(s)
- Chi Wen
- 1 Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shelley H Liu
- 2 Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yan Li
- 2 Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,3 Center for Health Innovation, New York Academy of Medicine, New York, NY, USA
| | - Perry Sheffield
- 1 Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- 1 Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,2 Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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15
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Bruzzese JM, Kingston S, Falletta KA, Bruzelius E, Poghosyan L. Individual and Neighborhood Factors Associated with Undiagnosed Asthma in a Large Cohort of Urban Adolescents. J Urban Health 2019; 96:252-261. [PMID: 30645702 PMCID: PMC6458186 DOI: 10.1007/s11524-018-00340-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Undiagnosed asthma adds to the burden of asthma and is an especially significant public health concern among urban adolescents. While much is known about individual-level demographic and neighborhood-level factors that characterize those with diagnosed asthma, limited data exist regarding these factors and undiagnosed asthma. This observational study evaluated associations between undiagnosed asthma and individual and neighborhood factors among a large cohort of urban adolescents. We analyzed data from 10,295 New York City adolescents who reported on asthma symptoms and diagnosis; a subset (n = 6220) provided addresses that we were able to geocode into US Census tracts. Multivariable regression models estimated associations between undiagnosed asthma status and individual-level variables. Hierarchical linear modeling estimated associations between undiagnosed asthma status and neighborhood-level variables. Undiagnosed asthma prevalence was 20.2%. Females had higher odds of being undiagnosed (adjusted odds ratio (AOR) = 1.25; 95% confidence interval (CI) = 1.13-1.37). Compared to White, non-Hispanic adolescents, Asian-Americans had higher risk of being undiagnosed (AOR = 1.41; 95% CI = 1.01-1.95); Latinos (AOR = 0.67; 95% CI = 0.45-0.83); and African-Americans/Blacks (AOR = 0.66; 95% CI = 0.52-0.87) had lower risk; Latinos and African-Americans/Blacks did not differ significantly. Living in a neighborhood with a lower concentration of Latinos relative to White non-Latinos was associated with lower risk of being undiagnosed (AOR = 0.66; CI = 0.43-0.95). Living in a neighborhood with health care provider shortages was associated with lower risk of being undiagnosed (AOR = 0.80; 95% CI =0.69-0.93). Public health campaigns to educate adolescents and their caregivers about undiagnosed asthma, as well as education for health care providers to screen adolescent patients for asthma, are warranted.
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Affiliation(s)
- Jean-Marie Bruzzese
- Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY, 10032, USA.
| | - Sharon Kingston
- Psychology Department, Dickinson College, P.O. Box 1773, Carlisle, PA, 17013, USA
| | - Katherine A Falletta
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Emilie Bruzelius
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Lusine Poghosyan
- Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY, 10032, USA
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16
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Glick AF, Tomopoulos S, Fierman AH, Elixhauser A, Trasande L. Association Between Outdoor Air Pollution Levels and Inpatient Outcomes in Pediatric Pneumonia Hospitalizations, 2007 to 2008. Acad Pediatr 2019; 19:414-420. [PMID: 30543871 PMCID: PMC6502659 DOI: 10.1016/j.acap.2018.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 11/30/2018] [Accepted: 12/09/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Pneumonia is a leading cause of pediatric admissions. Although air pollutants are associated with poor outcomes, few national studies have examined associations between pollutant levels and inpatient pediatric pneumonia outcomes. We examined the relationship between ozone (O3) and fine particulate matter with a diameter ≤2.5 µm (PM2.5) and outcomes related to disease severity. METHODS In this cross-sectional study, we obtained discharge data from the 2007 to 2008 Nationwide Inpatient Sample and pollution data from the Air Quality System. Patients ≤18years with a principal diagnosis of pneumonia were included. Discharge data were linked to O3 and PM2.5 levels (predictors) from the patient's ZIP Code (not publicly available) from day of admission. Outcomes were mortality, intubation, length of stay (LOS), and total costs. We calculated weighted national estimates and performed multivariable analyses adjusting for sociodemographic and hospital factors. RESULTS There were a total of 57,972 (278,871 weighted) subjects. Median PM2.5 level was 9.5 (interquartile range [IQR] 6.8-13.4) µg/m3. Median O3 level was 35.6 (IQR 28.2-45.2) parts per billion. Mortality was 0.1%; 0.75% of patients were intubated. Median LOS was 2 (IQR 2-4) days. Median costs were $3089 (IQR $2023-$5177). Greater levels of PM2.5 and O3 were associated with mortality, longer LOS, and greater costs. Greater O3 levels were associated with increased odds of intubation. CONCLUSIONS Greater levels of O3 and PM2.5 were associated with more severe presentations of pneumonia. Future work should examine these relationships in more recent years and over a longer time period.
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Affiliation(s)
- Alexander F. Glick
- Department of Pediatrics, NYU Langone Health/Bellevue Hospital Center, 462 First Avenue, New York, NY, 10016, USA,Corresponding Author Alexander F. Glick, MD, MS, Bellevue Hospital Center, Department of Pediatrics, Administration Building, Third Floor, 462 First Avenue, New York, NY 10016, Phone: 212-562-2455, Fax: 212-562-5518,
| | - Suzy Tomopoulos
- Department of Pediatrics, NYU Langone Health/Bellevue Hospital Center, 462 First Avenue, New York, NY, 10016, USA
| | - Arthur H. Fierman
- Department of Pediatrics, NYU Langone Health/Bellevue Hospital Center, 462 First Avenue, New York, NY, 10016, USA
| | - Anne Elixhauser
- Formerly from the Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Leonardo Trasande
- Department of Pediatrics, NYU Langone Health/Bellevue Hospital Center, 462 First Avenue, New York, NY, 10016, USA,Departments of Environmental Medicine and Population Health, NYU School of Medicine, 403 East 34th Street, Rm 115, New York, NY, 10016, USA,NYU Wagner School of Public Service, New York, NY, 403 East 34th Street, Rm 115, New York, NY, 10016, USA,NYU College of Global Public Health, 403 East 34th Street, Rm 115, New York, NY, 10016, USA
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17
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Anttila A, Rappaport DI, Tijerino J, Zaman N, Sharif I. Interpretation Modalities Used on Family-Centered Rounds: Perspectives of Spanish-Speaking Families. Hosp Pediatr 2017; 7:492-498. [PMID: 28705913 DOI: 10.1542/hpeds.2016-0209] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Limited-English-proficient (LEP) patients and families are at risk for worse hospital outcomes due to impaired communication. Family-centered rounds (FCR) have become the preferred format for information sharing among providers and families at pediatric institutions. However, there are limited data on FCR among LEP families, particularly regarding interpretation type. We sought to examine the relationships between interpretation type and FCR satisfaction and efficacy among Spanish-speaking families, the fastest growing LEP population in pediatric hospitals. METHODS Spanish speakers admitted to general pediatrics units over a period of 16 months were identified on admission. A bilingual research assistant observed FCR and completed an observation tool, including interpreter type. After FCR, the research assistant interviewed families, collecting parent demographics, FCR experience, and interpreter satisfaction. Associations between interpretation type and satisfaction as well as interpretation type and understanding were tested by using χ2 analyses. RESULTS We studied 124 families over 16 months. Most respondents were patients' mothers (84%), born in Mexico (76%), had grade school education (56%), and spoke limited English (96%). Overall, 83 (73%) reported the interpreter services improved their understanding of their child's medical condition. Interpreter type was significantly associated with family satisfaction with FCR; specifically, an in-person hospital interpreter or video interpreter was associated with complete caregiver satisfaction (P = .005). CONCLUSIONS Spanish speakers report higher satisfaction with face-to-face interpreters during FCR, including in-person and video, compared with telephonic interpreters. Video interpretation via iPad during FCR may be a valuable and accessible approach to improve communication in the care of hospitalized children.
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Affiliation(s)
- Ashley Anttila
- General Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; and
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - David I Rappaport
- General Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; and
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Johan Tijerino
- General Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; and
| | - Nusrat Zaman
- General Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; and
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Iman Sharif
- General Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware; and
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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18
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Lion KC, Wright DR, Desai AD, Mangione-Smith R. Costs of Care for Hospitalized Children Associated With Preferred Language and Insurance Type. Hosp Pediatr 2017; 7:70-78. [PMID: 28073815 DOI: 10.1542/hpeds.2016-0051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The study goal was to determine whether preferred language for care and insurance type are associated with cost among hospitalized children. METHODS A retrospective cohort study was conducted of inpatients at a freestanding children's hospital from January 2011 to December 2012. Patient information and hospital costs were obtained from administrative data. Cost differences according to language and insurance were calculated using multivariate generalized linear model estimates, allowing for language/insurance interaction effects. Models were also stratified according to medical complexity and length of stay (LOS) ≥3 days. RESULTS Of 19 249 admissions, 8% of caregivers preferred Spanish and 6% preferred another language; 47% of admissions were covered by public insurance. Models controlled for LOS, medical complexity, home-to-hospital distance, age, asthma diagnosis, and race/ethnicity. Total hospital costs were significantly higher for publicly insured Spanish speakers ($20 211 [95% confidence interval (CI), 7781 to 32 641]) and lower for privately insured Spanish speakers (-$16 730 [95% CI, -28 265 to -5195]) and publicly insured English speakers (-$4841 [95% CI, -6781 to -2902]) compared with privately insured English speakers. Differences were most pronounced among children with medical complexity and LOS ≥3 days. CONCLUSIONS Hospital costs varied significantly according to preferred language and insurance type, even adjusting for LOS and medical complexity. These differences in the amount of billable care provided to medically similar patients may represent either underprovision or overprovision of care on the basis of sociodemographic factors and communication, suggesting problems with care efficiency and equity. Further investigation may inform development of effective interventions.
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Affiliation(s)
- K Casey Lion
- Department of Pediatrics, University of Washington, Seattle, Washington; and .,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Davene R Wright
- Department of Pediatrics, University of Washington, Seattle, Washington; and.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Arti D Desai
- Department of Pediatrics, University of Washington, Seattle, Washington; and.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Rita Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle, Washington; and.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
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19
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Zhang Q, Lamichhane R, Diggs LA. Disparities in emergency department visits in American children with asthma: 2006-2010. J Asthma 2016; 54:679-686. [PMID: 27880053 DOI: 10.1080/02770903.2016.1263315] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This article was to examine the trends in emergency department (ED) visits for asthma among American children in 2006-2010 across sociodemographic factors, parental smoking status, and children's body weight status. METHODS We analyzed 5,535 children aged 2-17 years with current asthma in the Asthma Call-Back Survey in 2006-2010. Multivariate log binomial regression was used to examine the disparities of ED visits by demographics, socioeconomic status, parental smoking status, children's body weight status, and the level of asthma control. We controlled for average state-level air pollutants. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were reported. RESULTS Minority children with current asthma had higher risks of ED visits compared with white children in 2009 and 2010, e.g., the PR (95% CI) for black children in 2009 was 3.64 (1.79, 7.41). Children who had current asthma and more highly educated parents experienced a higher risk of ED visits in 2007 (PRs [95% CI] = 2.15 [1.02, 4.53] and 2.97 [1.29, 6.83] for children with some college or college-graduated parents), but not significant in other years. Children with uncontrolled asthma were significantly more likely to visit the ED in 2008 (PRs [95% CI] = 2.79 [1.44, 5.41] and 6.96 [3.55, 13.64] for not-well-controlled and very poorly controlled children with asthma). CONCLUSIONS Minority children with current asthma or children with uncontrolled asthma were more likely to visit EDs for asthma treatment. However, the disparities in ED visits across sociodemographics, health status, or asthma control vary in scale and significance across time. More research is needed to explain these differences.
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Affiliation(s)
- Qi Zhang
- a School of Community and Environmental Health, Old Dominion University , Norfolk , VA , USA
| | - Rajan Lamichhane
- b Department of Mathematics , Texas A&M University-Kingsville , Kingsville , TX , USA
| | - Leigh Ann Diggs
- a School of Community and Environmental Health, Old Dominion University , Norfolk , VA , USA
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