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Campbell JI, Tolliver DG, He Y, Wang RY, Shapiro J, Shanahan K, Mell A, Luercio M, Shah SN, Hall M, Goel AK, Melvin P, Ward VL, Berry J. Leaving Against Medical Advice From Children's Hospitals. Pediatrics 2024:e2023064958. [PMID: 39380538 DOI: 10.1542/peds.2023-064958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 07/19/2024] [Accepted: 07/24/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND Leaving the hospital against medical advice (AMA) reflects a breakdown in the family-clinician relationship and creates ethical dilemmas in inpatient pediatric care. There are no national data on frequency or characteristics of leaving AMA from US children's hospitals. METHODS We performed a retrospective cohort study of hospital discharges for children under 18 years old from January 1, 2018 to December 31, 2022 in 43 children's hospitals in the Pediatric Health Information System (PHIS) database. The primary outcome was leaving AMA. Exposures were demographic, geographic, and clinical characteristics. We used multivariable mixed effects logistic regression models to assess independent factors associated with leaving AMA and all-cause 14-day hospital readmission. RESULTS Among 3 672 243 included inpatient encounters, 2972 (0.08%) ended in leaving AMA. Compared with non-Hispanic white patients, non-Hispanic Black patients had higher odds of leaving AMA (adjusted odds ratio [aOR] 1.31 [95% confidence interval (CI) 1.19-1.44]), whereas Hispanic patients (aOR 0.66 [95% CI 0.59-0.75]) had lower odds of leaving AMA. Hospitalizations for patients with noncommercial insurance were more likely to end in leaving AMA. Leaving AMA was associated with increased odds of 14-day inpatient readmission (aOR 1.41 [95% CI 1.24-1.61]) compared with patients who did not leave AMA. There was substantial interhospital variability in standardized rates of leaving AMA (range 0.18-2.14 discharges per 1000 inpatient encounters). CONCLUSIONS Approximately 1 in 1235 inpatient encounters ended in leaving AMA. Non-Hispanic Black patients had increased odds of leaving AMA. Leaving AMA was associated with increased odds of 14-day readmission.
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Affiliation(s)
- Jeffrey I Campbell
- Section of Pediatric Infectious Diseases
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Destiny G Tolliver
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Yuan He
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rita Y Wang
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
- Boston Combined Residency Program, Boston Children's Hospital and Boston Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Joseph Shapiro
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Kristen Shanahan
- Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Mass General for Children, Boston, Massachusetts
| | - Anthony Mell
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Marcella Luercio
- Harvard Medical School, Boston, Massachusetts
- Department of Pediatrics
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
- Office of Health Equity and Inclusion
| | - Snehal N Shah
- Harvard Medical School, Boston, Massachusetts
- Department of Pediatrics
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
- Office of Health Equity and Inclusion
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Anuj K Goel
- Office of General Counsel, Boston Children's Hospital, Boston, Massachusetts
| | - Patrice Melvin
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
- Office of Health Equity and Inclusion
| | - Valerie L Ward
- Department of Pediatrics
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
- Office of Health Equity and Inclusion
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jay Berry
- Harvard Medical School, Boston, Massachusetts
- Department of Pediatrics
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2
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Masciale M, Garg A, Lopez MA. Momentous Times for Social Needs Screening: Should Hospitalists Ride the Tide or Create the Waves? Hosp Pediatr 2024:e2024008069. [PMID: 39370895 DOI: 10.1542/hpeds.2024-008069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 10/08/2024]
Affiliation(s)
- Marina Masciale
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Arvin Garg
- Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
| | - Michelle A Lopez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Center for Child Health Policy and Advocacy, Texas Children's Hospital, Houston, Texas
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3
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Magee PM, Asp RA, Myers CN, Grunwell JR, Paquette E, Akande MY. Assessing Social Determinants of Health During Critical Illness: Implications and Methodologies. Crit Care Clin 2024; 40:623-640. [PMID: 39218477 DOI: 10.1016/j.ccc.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
A growing body of literature has identified social determinants of health (SDoH) as potential contributors to health disparities in pediatric critical illness. Pediatric critical care providers should use validated screening tools to identify unmet social needs and ensure appropriate referral through multisector partnerships. Pediatric critical care researchers should consider factors outside of race and insurance status and explore the association between neighborhood-level factors and disparate health outcomes during critical illness. Measuring and addressing the SDoH at the individual and neighborhood level are important next steps in mitigating health disparities for critically ill pediatric patients.
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Affiliation(s)
- Paula M Magee
- Division of Pediatric Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, 9 Main Suite 9NW45, Philadelphia, PA 19104, USA.
| | - Rebecca A Asp
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, 3333 Burnet Avenue, ML 2005, Cincinnati, OH 45229, USA
| | - Carlie N Myers
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, 3333 Burnet Avenue, ML 2005, Cincinnati, OH 45229, USA
| | - Jocelyn R Grunwell
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Road Northeast, Tower 1, 4th Floor, PCCM Offices, Atlanta GA 30322, USA. https://twitter.com/GrunwellJocelyn
| | - Erin Paquette
- Division of Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Chicago, IL 60611, USA
| | - Manzilat Y Akande
- Section of Critical Care, Department of Pediatrics, Oklahoma University Health Sciences Center, 1100 North Lindsay Avenue, Oklahoma City, OK 73104, USA
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4
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Kern-Goldberger AS, Bracy D, Szymczak JE, Gonzalez D, Rothberg MB, Gerber JS, Bonafide CP. Drivers of Inpatient Subspecialty Consultation Among Pediatric Hospitalists: A Qualitative Study. Hosp Pediatr 2024; 14:782-789. [PMID: 39188250 DOI: 10.1542/hpeds.2023-007589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/29/2024] [Accepted: 04/06/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Inpatient subspecialty consultation is often medically necessary but in some cases may represent overuse. While pediatric consultation patterns have been described using observational data, qualitative methods may generate knowledge about contextual determinants of consultation behavior. Our objective was to understand how pediatric hospitalists make decisions about subspecialty consultation. METHODS This qualitative study took place at a large academic children's hospital as part of an explanatory sequential mixed-methods design (QUAN → qual). We conducted semistructured interviews with a purposive sample of previously identified high-consulting (top quartile) and low-consulting (bottom quartile) pediatric hospitalists. Interviews were conducted virtually, and audio recordings were transcribed. Two analysts coded transcripts using an integrated approach and established high interrater reliability (κ > 0.75). We organized findings using the Social Ecological Model. RESULTS Participants (n = 12) included high-(n = 6) and low-(n = 6) consulting hospitalists. Our respondents identified considerations including patient characteristics, confidence in their own competence and that of their team, and perceived helpfulness of consultants. Participants viewed consultation requests as being strongly influenced by a desire to maintain relationships with families. Specific to this context, the hospital's elite reputation was believed to influence families to expect consultations. Other considerations included medicolegal risk, clinical pathways, and availability of secure text messaging to facilitate informal "curbside" conversations with subspecialists. CONCLUSIONS Decision-making around pediatric subspecialty consultation is complex and influenced by factors unrelated to a patient's clinical need. Efforts to reduce low-value consultation must account for the social and organizational dynamics that promote consultation.
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Affiliation(s)
- Andrew S Kern-Goldberger
- Division of Pediatric Hospital Medicine
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | - Danny Bracy
- Mixed-Methods Research Laboratory, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia E Szymczak
- Clinical Futures, a Center of Emphasis within the CHOP Research Institute
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Denise Gonzalez
- Mixed-Methods Research Laboratory, Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael B Rothberg
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey S Gerber
- Clinical Futures, a Center of Emphasis within the CHOP Research Institute
- Division of Infectious Diseases
- Department of Pediatrics, Perelman School of Medicine
| | - Christopher P Bonafide
- Clinical Futures, a Center of Emphasis within the CHOP Research Institute
- Section of Pediatric Hospital Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania
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5
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Dixon GL, Peña MM, Ellison AM, Johnson TJ. Equity in Pediatric Hospital-Based Safety and Quality Improvement. Acad Pediatr 2024; 24:S184-S188. [PMID: 39428152 DOI: 10.1016/j.acap.2024.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 01/27/2024] [Accepted: 01/31/2024] [Indexed: 10/22/2024]
Abstract
There are well-documented inequities in the quality of care and health outcomes of minoritized youth. Patient safety and quality improvement (QI) work with an equity focus has been identified as an important strategy to remedy these existing inequities. In this article, we will present evidence of inequities in pediatric hospital-based care, describe root causes with a focus on structural racism, highlight existing frameworks for applying equity principles to patient safety and QI, and provide best practices and recommendations on evaluating patient safety and QI data towards advancing equity in pediatric hospital-based care.
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Affiliation(s)
- Gabrina L Dixon
- Division of Hospital Medicine (GL Dixon), Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Michelle-Marie Peña
- Division of Neonatology (M-M Peña), Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Ga
| | - Angela M Ellison
- Division of Emergency Medicine (AM Ellison), Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Tiffani J Johnson
- Division of Emergency Medicine (TJ Johnson), University of California, Davis, Sacramento, Calif
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Bryan MA, Mihalek AJ. Gaps in Immunizing Children During Hospitalization: How Can We Close Them? Hosp Pediatr 2024; 14:e391-e393. [PMID: 39099439 PMCID: PMC11358594 DOI: 10.1542/hpeds.2024-007884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 05/16/2024] [Accepted: 06/02/2024] [Indexed: 08/06/2024]
Affiliation(s)
- Mersine A. Bryan
- Division of Hospital Medicine, Department of Pediatrics, University of Washington, Seattle, Washington
- Seattle Children’s Research Institute, Seattle, Washington
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7
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Garg A, Sochet AA, Hernandez R, Stockwell DC. Association of the Child Opportunity Index and Inpatient Illness Severity in the United States, 2018-2019. Acad Pediatr 2024; 24:1101-1109. [PMID: 38159600 PMCID: PMC11211241 DOI: 10.1016/j.acap.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Children residing in impoverished neighborhoods have reduced access to health care resources. Our objective was to identify potential associations between Child Opportunity Index (COI), a composite score of neighborhood characteristics, and inpatient severity of illness and clinical trajectory among United States (US) children. METHODS This retrospective cohort study assessed data using the Pediatric Health Information System Registry from 2018 to 2019. Primary exposure variable was COI level (range: very low [CO1 1], low [COI 2], moderate [COI 3], high [COI 4], and very high [COI 5]). Markers of inpatient clinical severity included index mortality, Pediatric Intensive Care Unit (PICU) admission, invasive mechanical ventilation (IMV), and hospital length of stay (LOS). Subgroup analysis of COI and clinical outcome variation by United States Census Geographic Regions was conducted. Adjusted regression analysis was utilized to understand associations between COI and inpatient clinical severity outcomes. RESULTS Of the 132,130 encounters, 44% resided in very low or low COI neighborhoods. In adjusted models, very low COI was associated with increased mortality (aOR: 1.35, 95% CI: 1.05-1.74, P = .018), PICU admission (aOR: 1.06, 95% CI: 1.02-1.11, P = 0.014), IMV (aOR: 1.12, 95% CI: 1.04-1.21, P = .002), and higher hospital LOS (P = .045). Regional variation by COI depicted the East North Central region having the highest rate of mortality (20.5%), P < .001, and PICU admissions (23%), P = .014. CONCLUSIONS Our multicenter, retrospective study highlights the interaction between neighborhood-level deprivation and worsened health disparities, indicating a need for prospective study.
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Affiliation(s)
- Anjali Garg
- Department of Anesthesia and Critical Care Medicine (A Garg, AA Sochet, and DC Stockwell), Johns Hopkins School of Medicine, Baltimore, Md.
| | - Anthony A Sochet
- Department of Anesthesia and Critical Care Medicine (A Garg, AA Sochet, and DC Stockwell), Johns Hopkins School of Medicine, Baltimore, Md; Department of Medicine (AA Sochet), Divisions of Pediatrics, Johns Hopkins All Children's Hospital Institute for Clinical and Translational Research, St. Petersburg, Fla
| | - Raquel Hernandez
- Pediatric Critical Care Medicine and Pediatrics (R Hernandez), Johns Hopkins All Children's Hospital Institute for Clinical and Translational Research, St. Petersburg, Fla; Department of Pediatrics (R Hernandez), Johns Hopkins University School of Medicine, Baltimore, Md
| | - David C Stockwell
- Department of Anesthesia and Critical Care Medicine (A Garg, AA Sochet, and DC Stockwell), Johns Hopkins School of Medicine, Baltimore, Md
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8
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Hall B, Tegge A, Cotache Condor C, Rhoads M, Wattsman TA, Witcher A, Creamer E, Tupetz A, Smith ER, Reddy Tokala M, Meier B, Rice HE. Understanding family-level decision-making when seeking access to acute surgical care for children: Protocol for a cross-sectional mixed methods study. PLoS One 2024; 19:e0304165. [PMID: 38913675 PMCID: PMC11195935 DOI: 10.1371/journal.pone.0304165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 05/03/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND There is limited understanding of how social determinants of health (SDOH) impact family decision-making when seeking surgical care for children. Our objectives of this study are to identify key family experiences that contribute to decision-making when accessing surgical care for children, to confirm if family experiences impact delays in care, and to describe differences in family experiences across populations (race, ethnicity, socioeconomic status, rurality). METHODS We will use a prospective, cross-sectional, mixed methods design to examine family experiences during access to care for children with appendicitis. Participants will include 242 parents of consecutive children (0-17 years) with acute appendicitis over a 15-month period at two academic health systems in North Carolina and Virginia. We will collect demographic and clinical data. Parents will be administered the Adult Responses to Children's Symptoms survey (ARCS), the child and parental forms of the Adverse Childhood Experiences (ACE) survey, the Accountable Health Communities Health-Related Social Needs Screening Tool, and Single Item Literacy Screener. Parallel ARCS data will be collected from child participants (8-17 years). We will use nested concurrent, purposive sampling to select a subset of families for semi-structured interviews. Qualitative data will be analyzed using thematic analysis and integrated with quantitative data to identify emerging themes that inform a conceptual model of family-level decision-making during access to surgical care. Multivariate linear regression will be used to determine association between the appendicitis perforation rate and ARCS responses (primary outcome). Secondary outcomes include comparison of health literacy, ACEs, and SDOH, clinical outcomes, and family experiences across populations. DISCUSSION We expect to identify key family experiences when accessing care for appendicitis which may impact outcomes and differ across populations. Increased understanding of how SDOH and family experiences influence family decision-making may inform novel strategies to mitigate surgical disparities in children.
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Affiliation(s)
- Bria Hall
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States of America
| | - Allison Tegge
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States of America
| | - Cesia Cotache Condor
- Duke Global Health Institute, Durham, NC, United States of America
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke Center for Global Surgery and Health Equity, Duke University School of Medicine, Durham, NC, United States of America
| | - Marie Rhoads
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States of America
| | - Terri-Ann Wattsman
- Department of Surgery, Carilion Clinic, Roanoke, VA, United States of America
| | - Angelica Witcher
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States of America
| | - Elizabeth Creamer
- School of Education, Virginia Tech University, Blacksburg, VA, United States of America
| | - Anna Tupetz
- Duke Global Health Institute, Durham, NC, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Emily R. Smith
- Duke Global Health Institute, Durham, NC, United States of America
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke Center for Global Surgery and Health Equity, Duke University School of Medicine, Durham, NC, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | - Mamata Reddy Tokala
- Health Analytics Research Team, Carilion Clinic, Roanoke, VA, United States of America
| | - Brian Meier
- Virginia Tech Carilion School of Medicine, Roanoke, VA, United States of America
- Department of Emergency Medicine, Carilion Clinic, Roanoke, VA, United States of America
| | - Henry E. Rice
- Duke Global Health Institute, Durham, NC, United States of America
- Department of Surgery, Duke University School of Medicine, Durham, NC, United States of America
- Duke Center for Global Surgery and Health Equity, Duke University School of Medicine, Durham, NC, United States of America
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9
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Lucey K, Jones RC, Watson JA, Malakooti M, Stephen RJ. Risk Factors for Deterioration Events in the Pediatric Acute Care Setting. Hosp Pediatr 2024; 14:e260-e266. [PMID: 38784994 DOI: 10.1542/hpeds.2023-007426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Rapid response system (RRS) activations resulting in emergency transfers (ETs) and codes outside the ICU are associated with increased mortality and length of stay. We aimed to evaluate the patient and care team characteristics of RRS activations resulting in ETs and codes outside the ICU (together classified as "deterioration events") versus those that did not result in a deterioration event. METHODS For each RRS activation at our institution from 2019 to 2021, data were gathered on patient demographics and medical diagnoses, care team and treatment factors, and ICU transfer. Descriptive statistics, bivariate analyses, and multivariable logistic regression using a backward elimination model selection method were performed to assess potential risk factors for deterioration events. RESULTS Over the 3-year period, 1765 RRS activations were identified. Fifty-three (3%) activations were deemed acute care codes, 64 (4%) were noncode ETs, 921 (52%) resulted in nonemergent transfers to an ICU, and 727 (41%) patients remained in an acute care unit. In a multivariable model, any complex chronic condition (adjusted odds ratio, 6.26; 95% confidence interval, 2.83-16.60) and hematology/oncology service (adjusted odds ratio, 2.19; 95% confidence interval, 1.28-3.74) were independent risk factors for a deterioration event. CONCLUSIONS Patients with medical complexity and patients on the hematology/oncology service had a higher risk of deterioration events than other patients with RRS activations. Further analyzing how our hospital evaluates and treats these specific patient populations is critical as we develop targeted interventions to reduce deterioration events.
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Affiliation(s)
- Kate Lucey
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Hospital Based Medicine
- Center for Quality and Safety
| | | | - J Andrew Watson
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Hospital Based Medicine
| | - Marcelo Malakooti
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Rebecca J Stephen
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Hospital Based Medicine
- Center for Quality and Safety
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10
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Raschein TS, Lammers S, Nickel A, Louie JP, Bergmann KR. Racial and Ethnic Differences in Hospital Admission and Diagnostic Evaluation for Febrile Seizures in the Emergency Department. J Pediatr 2024; 269:113960. [PMID: 38369236 DOI: 10.1016/j.jpeds.2024.113960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/25/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To examine differences in hospital admission and diagnostic evaluation for febrile seizure by race and ethnicity. STUDY DESIGN We conducted a cross-sectional study among children 6 months to 6 years with simple or complex febrile seizure between January 1, 2016, and December 31, 2021, using data from the Pediatric Health Information System. The primary outcome was hospital admission. Secondary outcomes included the proportion of encounters with neuroimaging or lumbar puncture. We used mixed-effects logistic regression model with random intercept for hospital and patient to estimate the association between outcomes and race and ethnicity after adjusting for covariates, including seizure type. RESULTS In total, 94 884 encounters were included. Most encounters occurred among children of non-Hispanic White (37.0%), Black (23.9%), and Hispanic/Latino (24.6%) race and ethnicity. Black and Hispanic/Latino children had 29% (aOR 0.71; 95% CI 0.66-0.75) and 26% (aOR 0.74; 95% CI 0.69-0.80) lower odds of hospital admission compared with non-Hispanic White children, respectively. Black and Hispanic/Latino children had 21% (aOR 0.79; 95% CI 0.73-0.86) and 22% (aOR 0.78; 95% CI 0.71-0.85) lower adjusted odds of neuroimaging compared with non-Hispanic White children. For complex febrile seizure, the adjusted odds of lumbar puncture was significantly greater among Asian children (aOR 2.12; 95% CI 1.19-3.77) compared with non-Hispanic White children. There were no racial differences in the odds of lumbar puncture for simple febrile seizure. CONCLUSIONS Compared with non-Hispanic White children, Black and Hispanic/Latino children with febrile seizures are less likely to be hospitalized or receive neuroimaging.
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Affiliation(s)
- Taryn S Raschein
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Shea Lammers
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Amanda Nickel
- Department of Research and Sponsored Programs, Children's Minnesota, Minneapolis, MN
| | - Jeffrey P Louie
- Division of Emergency Medicine, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Kelly R Bergmann
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN.
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11
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Saw-Aung M, Kong RM, Cipriano N, Daniels A, Newen NL, Goldstein NA, Plum AW. National Trends of Pediatric Aspirated/Ingested Foreign Bodies. Clin Pediatr (Phila) 2024; 63:531-540. [PMID: 37377192 DOI: 10.1177/00099228231181978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Foreign body (FB) aspiration/ingestion in children represents a major cause of hospital admission and mortality. Evaluating risk factors and identifying trends in specific FB products could improve targeted health literacy and policy changes. A cross-sectional study querying emergency department patients less than 18 years old with a diagnosis of aspirated/ingested FB was conducted using the National Electronic Injury Surveillance System database between 2010 and 2020. Incidence rates per 100 000 people-year were calculated and multivariate analyses were performed to identify risk factors for hospital admission and mortality. There has been a significantly decreasing rate of aspirated (-23.6%; P = .013) but not ingested FB (-9.4%; P = .066) within the study period. Within pediatric aspirated FB, black compared with white patients had decreased odds of same hospital admission (odds ratio [OR]: 0.8), but increased odds of transfer admission (OR: 1.6) and mortality (OR: 9.2) (all, P < .001).
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Affiliation(s)
- Monica Saw-Aung
- Department of Otolaryngology, School of Medicine, SUNY Downstate, Brooklyn, NY, USA
| | - Ryan M Kong
- Department of Otolaryngology, School of Medicine, SUNY Downstate, Brooklyn, NY, USA
| | - Natalie Cipriano
- Department of Otolaryngology, School of Medicine, SUNY Downstate, Brooklyn, NY, USA
| | - Adam Daniels
- Department of Otolaryngology, School of Medicine, SUNY Downstate, Brooklyn, NY, USA
| | - Naomi L Newen
- Department of Otolaryngology, School of Medicine, SUNY Downstate, Brooklyn, NY, USA
| | - Nira A Goldstein
- Department of Otolaryngology, School of Medicine, SUNY Downstate, Brooklyn, NY, USA
| | - Ann W Plum
- Department of Otolaryngology, School of Medicine, SUNY Downstate, Brooklyn, NY, USA
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12
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Schechter SB, Bowles A, Ding L, Nkoy F, Tieder J, Lion KC, Meyer D, Kaiser SV. Hospital-Based Pediatric Quality Improvement Interventions and Health Disparities: A Scoping Review of the Literature. Pediatrics 2024; 153:e2022061176. [PMID: 38666310 DOI: 10.1542/peds.2022-061176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Quality improvement (QI) has the potential to reduce health disparities through multiple mechanisms, including by standardizing care and addressing social barriers to health. National organizations require that hospital systems integrate equity into quality efforts, but effective approaches remain unclear. We aimed to examine the association of hospital-based pediatric QI interventions and racial and ethnic, language, and socioeconomic disparities in health outcomes. METHODS Quantitative studies from January 1, 2000 to December 11, 2023 reporting the effects of pediatric hospital-based QI were selected from PubMed and Embase. Studies were excluded if outcomes were not stratified by race and ethnicity, language, or socioeconomic status. Studies were reviewed in duplicate for inclusion and by 1 author for data extraction. RESULTS A total of 22 studies were included. Most studies (n = 19, 86%) revealed preexisting disparities, and 68% of those (n = 13) found disparities reductions post-intervention. Studies with disparity-focused objectives or interventions more commonly found reduced disparities than studies of general QI (85% vs 33%). Hospital-based process standardization was associated with reduced disparities in provider practices. Most interventions associated with reduced disparities in patient-facing outcomes involved community/ambulatory partnership. Limitations included potential exclusion of relevant studies, topic heterogenity, and risk of bias. CONCLUSIONS Although the authors of few published hospital-based QI initiatives assessed their equity effect, intentionally designed QI studies were associated with reduced disparities. Interventions focused on care standardization may reduce disparities in care quality, although multilevel interventions are likely needed to affect the health care structures that influence more significant patient outcomes.
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Affiliation(s)
| | - Adria Bowles
- University of California, San Francisco, San Francisco, California
| | - Lucky Ding
- University of California, San Francisco, San Francisco, California
| | - Flory Nkoy
- University of Utah, Salt Lake City, Utah
| | - Joel Tieder
- University of Washington, Seattle, Washington
| | | | - Dodi Meyer
- Columbia University Irving Medical Center, New York, New York
| | - Sunitha V Kaiser
- University of California, San Francisco, San Francisco, California
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13
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Cochran ED, Jacobson JC, Nehrubabu M, Qiao J, McCreery S, Chung DH. Social Determinants of Outcomes Disparity among Pediatric Patients with Solid Tumor. J Am Coll Surg 2024; 238:463-478. [PMID: 38258890 DOI: 10.1097/xcs.0000000000001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Socioeconomic factors have a significant impact on healthcare outcomes. Metrics such as area deprivation index (ADI) are used to quantify the anticipated influence of these factors. Here, we sought to assess the impact of socioeconomic factors on clinical outcomes among pediatric patients with solid tumor in our region. STUDY DESIGN We identified 3,863 pediatric patients who were diagnosed with a malignant solid tumor in the Texas Cancer Registry between 1995 and 2019. ADI was used to quantify socioeconomic determinants of health. These outcome variables were determined: stage of disease at diagnosis, time between diagnosis and treatment initiation, and overall mortality. Statistical analysis was performed using logistic regression, linear regression, Cox proportional hazards regression, and Kaplan-Meier survival curves. RESULTS A total of 53.5% of patients were male and the average age at diagnosis was 4.5 years. Forty-seven percent of patients were White, 13.3% were Black, 36.2% were Hispanic, 1.7% were Asian, and other rare minority groups made up 1.8%. On multivariable analysis, increased risk of death was associated with Black race, rare minority race, residence in a border county, and increasing ADI score, with the risk of death at 5 years rising 4% with each increasing ADI point. CONCLUSIONS Social determinants of health are associated with disparate outcomes among pediatric patients with solid tumor. Our results suggest that patients who are part of racial minority groups and those who reside in socioeconomically disadvantaged neighborhoods or regions near the Texas-Mexico border are at an increased risk of death. This information may be useful in strategizing outreach and expanding resources to improve outcomes in at-risk communities.
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Affiliation(s)
- Elizabeth D Cochran
- From the Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Cochran, Jacobson, Qiao, McCreery, Chung)
| | - Jillian C Jacobson
- From the Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Cochran, Jacobson, Qiao, McCreery, Chung)
| | - Mithin Nehrubabu
- Department of Mathematical Sciences, University of Dallas, Dallas, TX (Nehrubabu)
| | - Jingbo Qiao
- From the Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Cochran, Jacobson, Qiao, McCreery, Chung)
| | - Sullivan McCreery
- From the Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Cochran, Jacobson, Qiao, McCreery, Chung)
| | - Dai H Chung
- From the Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX (Cochran, Jacobson, Qiao, McCreery, Chung)
- Children's Health, Dallas, TX (Chung)
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14
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Mahant S, Borkhoff CM, Parkin PC, Imsirovic H, Tuna M, Macarthur C, To T, Gill PJ. Sociodemographic Factors and Trends in Bronchiolitis-Related Emergency Department Visit and Hospitalization Rates. JAMA Netw Open 2024; 7:e248976. [PMID: 38683605 PMCID: PMC11059049 DOI: 10.1001/jamanetworkopen.2024.8976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/28/2024] [Indexed: 05/01/2024] Open
Abstract
Importance Bronchiolitis is the most common and most cumulatively expensive condition in pediatric hospital care. Few population-based studies have examined health inequalities in bronchiolitis outcomes over time. Objective To examine trends in bronchiolitis-related emergency department (ED) visit and hospitalization rates by sociodemographic factors in a universally funded health care system. Design, Setting, and Participants This repeated cross-sectional cohort study was performed from April 1, 2004, to March 31, 2022, using population-based health administrative data from children younger than 2 years in Ontario, Canada. Main Outcome and Measures Bronchiolitis ED visit and hospitalization rates per 1000 person-years reported for the equity stratifiers of sex, residence location (rural vs urban), and material resources quintile. Trends in annual rates by equity stratifiers were analyzed using joinpoint regression and estimating the average annual percentage change (AAPC) with 95% CI and the absolute difference in AAPC with 95% CI from April 1, 2004, to March 31, 2020. Results Of 2 921 573 children included in the study, 1 422 088 (48.7%) were female and 2 619 139 (89.6%) lived in an urban location. Emergency department visit and hospitalization rates were highest for boys, those with rural residence, and those with least material resources. There were no significant between-group absolute differences in the AAPC in ED visits per 1000 person-years by sex (female vs male; 0.22; 95% CI, -0.92 to 1.35; P = .71), residence (rural vs urban; -0.31; 95% CI -1.70 to 1.09; P = .67), or material resources (quintile 5 vs 1; -1.17; 95% CI, -2.57 to 0.22; P = .10). Similarly, there were no significant between-group absolute differences in the AAPC in hospitalizations per 1000 person-years by sex (female vs male; 0.53; 95% CI, -1.11 to 2.17; P = .53), residence (rural vs urban; -0.62; 95% CI, -2.63 to 1.40; P = .55), or material resources (quintile 5 vs 1; -0.93; 95% CI -3.80 to 1.93; P = .52). Conclusions and Relevance In this population-based cohort study of children in a universally funded health care system, inequalities in bronchiolitis ED visit and hospitalization rates did not improve over time.
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Affiliation(s)
- Sanjay Mahant
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Pediatric Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Cornelia M. Borkhoff
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia C. Parkin
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Pediatric Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Pediatric Medicine and the Pediatric Outcomes Research Team, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Meltem Tuna
- ICES, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Colin Macarthur
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Teresa To
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Peter J. Gill
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Pediatric Medicine, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Williams S, Hill K, Mathew MS, Messiah SE. Disparities in Patient Family Social Determinants of Health in a Large Urban Pediatric Health System. J Pediatr Health Care 2024; 38:172-183. [PMID: 38429029 DOI: 10.1016/j.pedhc.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/20/2023] [Accepted: 11/18/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION This analysis sought to identify disparities in social determinants of health (SDOH) outcomes at a Texas pediatric hospital. METHODS This retrospective study used electronic health records of pediatric patients families surveyed August -December 2022. Outcomes for health literacy, social support, food, transportation, energy, digital, and housing insecurity, and tobacco exposure were analyzed across demographic categories. RESULTS Among 15,294 respondents to the survey (mean child age, 8.73 years; 43.68% Hispanic, 29.73% non-Hispanic White, 18.27% non-Hispanic Black, 6.79% other race/ethnicity; 53.95% male), 50.25% of respondents reported at least one SDOH, whereas 23.39% reported two or more SDOH. The most prevalent SDOH was lack of social support (3,456, 23.91%). Hispanic, non-Hispanic Black, and other race/ethnicity respondents, non-English speakers, and public insurance users had higher odds of reporting almost all SDOH in logistic regression models adjusted for age, race/ethnicity, language, gender, and insurance type. DISCUSSION Race/ethnicity, language, and insurance type disparities were identified for all SDOH.
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16
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Parikh K, Hall M, Tieder JS, Dixon G, Ward MC, Hinds PS, Goyal MK, Rangel SJ, Flores G, Kaiser SV. Disparities in Racial, Ethnic, and Payer Groups for Pediatric Safety Events in US Hospitals. Pediatrics 2024; 153:e2023063714. [PMID: 38343330 DOI: 10.1542/peds.2023-063714] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Health care disparities are pervasive, but little is known about disparities in pediatric safety. We analyzed a national sample of hospitalizations to identify disparities in safety events. METHODS In this population-based, retrospective cohort study of the 2019 Kids' Inpatient Database, independent variables were race, ethnicity, and payer. Outcomes were Agency for Healthcare Research and Quality pediatric safety indicators (PDIs). Risk-adjusted odds ratios were calculated using white and private payer reference groups. Differences by payer were evaluated by stratifying race and ethnicity. RESULTS Race and ethnicity of the 5 243 750 discharged patients were white, 46%; Hispanic, 19%; Black, 15%; missing, 8%; other race/multiracial, 7%, Asian American/Pacific Islander, 5%; and Native American, 1%. PDI rates (per 10 000 discharges) were 331.4 for neonatal blood stream infection, 267.5 for postoperative respiratory failure, 114.9 for postoperative sepsis, 29.5 for postoperative hemorrhage/hematoma, 5.6 for central-line blood stream infection, 3.5 for accidental puncture/laceration, and 0.7 for iatrogenic pneumothorax. Compared with white patients, Black and Hispanic patients had significantly greater odds in 5 of 7 PDIs; the largest disparities occurred in postoperative sepsis (adjusted odds ratio, 1.55 [1.38-1.73]) for Black patients and postoperative respiratory failure (adjusted odds ratio, 1.34 [1.21-1.49]) for Hispanic patients. Compared with privately insured patients, Medicaid-covered patients had significantly greater odds in 4 of 7 PDIs; the largest disparity occurred in postoperative sepsis (adjusted odds ratios, 1.45 [1.33-1.59]). Stratified analyses demonstrated persistent disparities by race and ethnicity, even among privately insured children. CONCLUSIONS Disparities in safety events were identified for Black and Hispanic children, indicating a need for targeted interventions to improve patient safety in the hospital.
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Affiliation(s)
- Kavita Parikh
- Children's National Hospital, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | | | - Gabrina Dixon
- Children's National Hospital, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Maranda C Ward
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Pamela S Hinds
- Children's National Hospital, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Monika K Goyal
- Children's National Hospital, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | | | - Glenn Flores
- Department of Pediatrics, University of Miami Miller School of Medicine, and Holtz Children's Hospital, Jackson Health System, Miami, Florida
| | - Sunitha V Kaiser
- University of California, San Francisco, California
- Philip R. Lee Institute for Health Policy Studies, San Francisco, California
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17
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Jeffries KN, Mundy A, Williford DE, Slagle B, Filipek J, Cantu RM. Impact of Preferred Written Language in Patients Discharged With Bronchiolitis From a Children's Hospital. Hosp Pediatr 2024; 14:e139-e143. [PMID: 38327219 DOI: 10.1542/hpeds.2023-007241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVES This study aimed to identify differences in length of stay and readmission in patients admitted with bronchiolitis based on preferred written language. A secondary aim was to assess adherence to providing written discharge instructions in patients' preferred language. METHODS In this cross-sectional study, we included 384 patients aged 0 to 2 years discharged from 2 children's hospitals with bronchiolitis from May 1, 2021, through April 30, 2022; patients were excluded for history of prematurity, complex chronic condition, or ICU stay during the study period. A manual chart review was performed to determine preferred written language and language of written discharge instructions. RESULTS Patients preferring a written language other than English had a longer length of stay compared with English-preferring patients (37.9 vs 34.3 hours, P < .05), but there was no significant difference in unplanned 7-day readmissions. All patients who preferred English and Spanish received written discharge instructions in their preferred written language; no patients with other preferred languages did. CONCLUSIONS Patients who preferred a written language other than English had a longer length of stay than those preferring English but there was no difference in 7-day readmissions, though power for readmissions was limited. The study also identified significant disparities in the provision of written discharge instructions in languages other than English and Spanish.
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Affiliation(s)
- Kristyn N Jeffries
- University of Arkansas for Medical Sciences, Department of Pediatrics, Little Rock, Arkansas
- Arkansas Children's Hospital, Little Rock, Arkansas
| | - Allison Mundy
- University of Arkansas College of Medicine, Little Rock, Arkansas
| | - Dustin E Williford
- University of Arkansas for Medical Sciences, Department of Pediatrics, Little Rock, Arkansas
- Arkansas Children's Hospital, Little Rock, Arkansas
| | - Brittany Slagle
- University of Arkansas for Medical Sciences, Department of Pediatrics, Little Rock, Arkansas
- Arkansas Children's Hospital, Little Rock, Arkansas
| | - Jacob Filipek
- University of Arkansas for Medical Sciences, Department of Pediatrics, Little Rock, Arkansas
- Arkansas Children's Hospital, Little Rock, Arkansas
| | - Rebecca M Cantu
- University of Arkansas for Medical Sciences, Department of Pediatrics, Little Rock, Arkansas
- Arkansas Children's Hospital, Little Rock, Arkansas
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18
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Shoag JM, Vu L, Cullen JC, Koroukian SM. Factors Associated With High Inpatient Utilization Among Children With Newly Diagnosed Cancer. Hosp Pediatr 2024; 14:e21-e24. [PMID: 38130180 DOI: 10.1542/hpeds.2023-007211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Jamie M Shoag
- Cleveland Clinic Children's Hospital, Cleveland, Ohio
- Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Long Vu
- Case Western Reserve University, Cleveland, Ohio
| | - Jennifer C Cullen
- Case Comprehensive Cancer Center, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
| | - Siran M Koroukian
- Case Comprehensive Cancer Center, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
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19
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Polich M, Mannino-Avila E, Edmunds M, Rungvivatjarus J, Patel A, Stucky-Fisher E, Rhee KE. Disparities in Management of Acute Gastroenteritis in Hospitalized Children. Hosp Pediatr 2023; 13:1106-1114. [PMID: 38013511 DOI: 10.1542/hpeds.2023-007283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND OBJECTIVES Acute gastroenteritis (AGE) is a common health care problem accounting for up to 200 000 pediatric hospitalizations annually. Previous studies show disparities in the management of children from different ethnic backgrounds presenting to the emergency department with AGE. Our aim was to evaluate whether differences in medical management also exist between Hispanic and non-Hispanic children hospitalized with AGE. METHODS We performed a single-center retrospective study of children aged 2 months to 12 years admitted to the pediatric hospital medicine service from January 2016 to December 2020 with a diagnosis of (1) acute gastroenteritis or (2) dehydration with feeding intolerance, vomiting, and/or diarrhea. Differences in clinical pathway use, diagnostic studies performed, and medical interventions ordered were compared between Hispanic and non-Hispanic patients. RESULTS Of 512 admissions, 54.9% were male, 51.6% were Hispanic, and 59.2% were on Medicaid. There was no difference between Hispanic and non-Hispanic patients in reported nausea or vomiting at admission, pathway use, or laboratory testing including stool studies. However, after adjusting for covariates, Hispanic patients had more ultrasound scans performed (odds ratio 1.65, 95% confidence interval 1.04-2.64) and fewer orders for antiemetics (odds ratio 0.53, 95% CI 0.29-0.95) than non-Hispanic patients. CONCLUSIONS Although there were no differences in many aspects of AGE management between Hispanic and non-Hispanic patients, there was still variability in ultrasound scans performed and antiemetics ordered, despite similarities in reported abdominal pain, nausea, and vomiting. Prospective and/or qualitative studies may be needed to clarify underlying reasons for these differences.
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Affiliation(s)
- Michelle Polich
- Rady Children's Hospital, San Diego, California, and University of California San Diego, San Diego, California
| | - Elizabeth Mannino-Avila
- Rady Children's Hospital, San Diego, California, and University of California San Diego, San Diego, California
| | - Michelle Edmunds
- Rady Children's Hospital, San Diego, California, and University of California San Diego, San Diego, California
| | - Jane Rungvivatjarus
- Rady Children's Hospital, San Diego, California, and University of California San Diego, San Diego, California
| | - Aarti Patel
- Rady Children's Hospital, San Diego, California, and University of California San Diego, San Diego, California
| | - Erin Stucky-Fisher
- Rady Children's Hospital, San Diego, California, and University of California San Diego, San Diego, California
| | - Kyung E Rhee
- Rady Children's Hospital, San Diego, California, and University of California San Diego, San Diego, California
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20
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Berlant ZS, Brighton HM, Estrada Guzman MC, Banker SL. Crossing the Bridge: Best Practices for the Care of Immigrant Children in Hospital Spaces. Hosp Pediatr 2023; 13:e351-e354. [PMID: 37800274 DOI: 10.1542/hpeds.2023-007176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Affiliation(s)
- Zachary S Berlant
- NewYork-Presbyterian Hospital, New York, New York
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Hadley M Brighton
- NewYork-Presbyterian Hospital, New York, New York
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
- Department of Pediatrics, Weill Cornell Medical Center, New York, New York
| | | | - Sumeet L Banker
- NewYork-Presbyterian Hospital, New York, New York
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
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21
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Tolliver DG, Edwards JG, Venkatesh AK. Interrupting Cascades of Physical Restraint as a Path to Health Equity for Hospitalized Children. Hosp Pediatr 2023; 13:e292-e294. [PMID: 37691615 DOI: 10.1542/hpeds.2023-007350] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
- Destiny G Tolliver
- Boston University Chobanian & Avedisian School of Medicine, Department of Pediatrics, Boston, Massachusetts
| | - Jeffrey G Edwards
- Boston Combined Residency Program in Pediatrics, Boston Medical Center and Boston Children's Hospital, Boston, Massachusetts
| | - Arjun K Venkatesh
- Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
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22
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Shah AN, Goodman E, Lawler J, Bosse D, Rubeiz C, Beck AF, Parsons A. Inpatient Screening of Parental Adversity and Strengths. Hosp Pediatr 2023; 13:922-930. [PMID: 37724391 DOI: 10.1542/hpeds.2022-007111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Social adversities, including health-harming social risks and adverse childhood experiences, contribute to poor outcomes after hospital discharge. Screening for social adversities is increasingly pursued in outpatient settings. Identifying and addressing such adversities has been linked to improved child outcomes. Screening for social adversities and strengths in the inpatient setting may contribute to better transitions from hospital to home. Our goal was twofold: 1. to use qualitative methods to understand parent perspectives around screening tools for potential use in inpatient settings; and 2. to develop a family-friendly inpatient screening tool for social adversity. METHODS We used in-depth, cognitive qualitative interviews with parents to elicit their views on existing screening tools covering social adversities and strengths. We partnered with a local nonprofit to recruit parents who recently had a child hospitalized or visited the emergency department. There were 2 phases of the study. In the first phase, we used qualitative methods to develop a screening prototype. In the second phase, we obtained feedback on the prototype. RESULTS We interviewed 18 parents who identified 3 major themes around screening: 1. factors that promote parents to respond openly and honestly during screening; 2. feedback about screening tools and the prototype; and 3. screening should include resources. CONCLUSIONS Social adversity routinely affects children; hospitalization is an important time to screen families for adversity and potential coexisting strengths. Using qualitative parent feedback, we developed the family friendly Collaborate to Optimize Parent Experience screening tool.
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Affiliation(s)
- Anita N Shah
- Divisions of Hospital Medicine
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | | | - Julianne Lawler
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Mehta P, Pan Z, Zhou W, Burger C, Menard-Katcher C, Bailey DD, Furuta GT. Examining Disparities in Pediatric Eosinophilic Esophagitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2855-2859. [PMID: 37321391 DOI: 10.1016/j.jaip.2023.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 05/18/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Little is known regarding the impact of race, ethnicity, and socioeconomic status on the health outcomes of children with eosinophilic esophagitis (EoE). OBJECTIVE To (1) identify demographic characteristics of children diagnosed with EoE in a large tertiary care center, and (2) determine associations between a patient's demographics and depth of evaluation or treatment choices. METHODS This retrospective cohort study included children 0 to 18 years old seen in Children's Hospital Colorado between January 1, 2009, and December 31, 2020. Demographics were extracted from the electronic medical record. Rural-Urban Commuting Area taxonomy codes were used to classify urbanization. Area Deprivation Index (ADI) scores were used to categorize neighborhood advantage/disadvantage. Data were analyzed using descriptive statistics and regression analysis. RESULTS The study included 2,117 children with EoE. Children with higher state ADI scores (greater neighborhood disadvantage) had less radiographic evaluation of their disease (odds ratio [95% CI] per unit increase in state ADI = 0.93 [0.89-0.97]; P = .0002) and had esophageal dilations at younger ages (r = -0.24; P = .007). Black children compared with White children were younger at diagnosis (8.3 y vs 10.0 y; P = .002). Children from rural areas were seen less by feeding therapy (3.9% vs 9.9%; P = .02), but were younger at their visits (2.3 y vs 4.3 y; P < .001). CONCLUSIONS In this study of children with EoE cared for in a large tertiary care center, we found differences in presentation and care depending on race, urbanization, and socioeconomic status.
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Affiliation(s)
- Pooja Mehta
- Gastrointestinal Eosinophilic Diseases Program, Digestive Health Institute, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
| | - Zhaoxing Pan
- Department of Biostatistics, University of Colorado School of Medicine, Aurora, Colo
| | - Wenru Zhou
- Department of Biostatistics, University of Colorado School of Medicine, Aurora, Colo
| | - Cassandra Burger
- Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
| | - Calies Menard-Katcher
- Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
| | - Dominique D Bailey
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Glenn T Furuta
- Gastrointestinal Eosinophilic Diseases Program, Digestive Health Institute, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
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Mayourian J, Brown E, Javalkar K, Bucholz E, Gauvreau K, Beroukhim R, Feins E, Kheir J, Triedman J, Dionne A. Insight into the Role of the Child Opportunity Index on Surgical Outcomes in Congenital Heart Disease. J Pediatr 2023; 259:113464. [PMID: 37172810 DOI: 10.1016/j.jpeds.2023.113464] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/20/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To use neighborhood-level Child Opportunity Index (COI) measures to investigate disparities in congenital heart surgery postoperative outcomes and identify potential targets for intervention. STUDY DESIGN In this single-institution retrospective cohort study, children <18 years old who underwent cardiac surgery between 2010 and 2020 were included. Patient-level demographics and neighborhood-level COI were used as predictor variables. COI-a composite US census tract-based score measuring educational, health/environmental, and social/economic opportunities-was dichotomized as lower (<40th percentile) vs higher (≥40th percentile). Cumulative incidence of hospital discharge was compared between groups using death as a competing risk, adjusting for clinical characteristics associated with outcomes. Secondary outcomes included hospital readmission and death within 30 days. RESULTS Among 6247 patients (55% male) with a median age of 0.8 years (IQR, 0.2-4.3), 26% had lower COI. Lower COI was associated with longer hospital lengths of stay (adjusted HR, 1.2; 95% CI, 1.1-1.2; P < .001) and an increased risk of death (adjusted OR, 2.0; 95% CI. 1.4-2.8; P < .001), but not hospital readmission (P = .6). At the neighborhood level, lacking health insurance coverage, food/housing insecurity, lower parental literacy and college attainment, and lower socioeconomic status were associated with longer hospital length of stay and increased risk of death. At the patient-level, public insurance (adjusted OR, 1.4; 95% CI, 1.0-2.0; P = .03) and caretaker Spanish language (adjusted OR 2.4; 95% CI, 1.2-4.3; P < .01) were associated with an increased risk of death. CONCLUSIONS Lower COI is associated with longer length of stay and higher early postoperative mortality. Risk factors identified including Spanish language, food/housing insecurity, and parental literacy serve as potential intervention targets.
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Affiliation(s)
- Joshua Mayourian
- Department of Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Pediatrics, Boston University, Boston, MA
| | - Ella Brown
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Karina Javalkar
- Department of Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Pediatrics, Boston University, Boston, MA
| | - Emily Bucholz
- Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Kimberlee Gauvreau
- Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Rebecca Beroukhim
- Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Eric Feins
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA
| | - John Kheir
- Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - John Triedman
- Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Audrey Dionne
- Department of Pediatrics, Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital, Boston, MA.
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Garg A, Lobner K, Song J, Mitchell R, Egbunine A, Kudchadkar SR. Social Determinants of Health in Pediatric Rehabilitation for Children with Traumatic Injury: A Systematic Review. J Pediatr 2023; 259:113459. [PMID: 37172806 PMCID: PMC10524504 DOI: 10.1016/j.jpeds.2023.113459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/05/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To examine the current evidence regarding health care disparities in pediatric rehabilitation after hospitalization with traumatic injury. STUDY DESIGN This systematic review utilized both PubMed and EMBASE, and each was searched with key MESH terms. Studies were included in the systematic review if they (1) addressed social determinants of health including, but not limited to, race, ethnicity, insurance status, and income level; (2) focused on inpatient and outpatient rehabilitation services posthospital stay; (3) were based in the pediatric population; and (4) addressed traumatic injury requiring hospitalization. Only studies from within the US were included. RESULTS From 10 169 studies identified, 455 abstracts were examined for full-text review, and 24 studies were chosen for data extraction. Synthesis of the 24 studies revealed 3 major themes: (1) access to services; (2) outcomes from rehabilitation; and (3) service provision. Patients with public insurance had decreased availability of service providers and had longer outpatient wait times. Non-Hispanic Black and Hispanic children were more likely to have greater injury severity and decreased functional independence after discharge. Lack of interpreter services was associated with decreased utilization of outpatient services. CONCLUSIONS This systematic review identified significant effects of health care disparities on the rehabilitation process in pediatric traumatic injury. Social determinants of health must be thoughtfully addressed to identify key areas of improvement for the provision of equitable health care.
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Affiliation(s)
- Anjali Garg
- Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Katie Lobner
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Ariel Egbunine
- Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pediatrics, Charlotte R. Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
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26
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Campbell JI, Shanahan KH, Bartick M, Ali M, Goldmann D, Shaikh N, Allende-Richter S. Racial and Ethnic Differences in Length of Stay for US Children Hospitalized for Acute Osteomyelitis. J Pediatr 2023; 259:113424. [PMID: 37084849 PMCID: PMC10527861 DOI: 10.1016/j.jpeds.2023.113424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/02/2022] [Accepted: 03/31/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE To examine the associations between race and ethnicity and length of stay (LOS) for US children with acute osteomyelitis. STUDY DESIGN Using the Kids' Inpatient Database, we conducted a cross-sectional study of children <21 years old hospitalized in 2016 or 2019 with acute osteomyelitis. Using survey-weighted negative binomial regression, we modeled LOS by race and ethnicity, adjusting for clinical and hospital characteristics and socioeconomic status. Secondary outcomes included prolonged LOS, defined as LOS of >7 days (equivalent to LOS in the highest quartile). RESULTS We identified 2388 children discharged with acute osteomyelitis. The median LOS was 5 days (IQR, 3-7). Compared with White children, children of Black race (adjusted incidence rate ratio [aIRR] 1.15; 95% CI, 1.05-1.27), Hispanic ethnicity (aIRR 1.11; 95% CI, 1.02-1.21), and other race and ethnicity (aIRR 1.12; 95% CI, 1.01-1.23) had a significantly longer LOS. The odds of Black children experiencing prolonged LOS was 46% higher compared with White children (aOR, 1.46; 95% CI, 1.01-2.11). CONCLUSIONS Children of Black race, Hispanic ethnicity, and other race and ethnicity with acute osteomyelitis experienced longer LOS than White children. Elucidating the mechanisms underlying these race- and ethnicity-based differences, including social drivers such as access to care, structural racism, and bias in provision of inpatient care, may improve management and outcomes for children with acute osteomyelitis.
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Affiliation(s)
- Jeffrey I Campbell
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA.
| | | | - Melissa Bartick
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA
| | - Mohsin Ali
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Don Goldmann
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA
| | - Nadia Shaikh
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL
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Wu AJ, Du N, Chen TYT, Fiechtner L. Sociodemographic Differences of Hospitalization and Associations of Resource Utilization for Failure to Thrive. J Pediatr Gastroenterol Nutr 2023; 76:385-389. [PMID: 36728758 PMCID: PMC9991948 DOI: 10.1097/mpg.0000000000003694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study examines the sociodemographic differences between elective and nonelective admissions for failure to thrive (FTT). We investigate associations between admission type and hospital resource utilization, including length of stay and feeding tube placement. METHODS We included children <2 years old with FTT in the nationwide Kids' Inpatient Database. We described differences between elective and nonelective admissions using Fisher exact and t tests. To assess associations of admission type and hospital resource utilization, we used negative binomial and logistic regression for length of stay and feeding tube placement, respectively. RESULTS In this study of 45,920 admissions (37,224 nonelective vs 8696 elective), we found differences by race and ethnicity, income, and insurance type, among other factors. Compared to elective admissions, nonelective admissions had higher proportions of infants who were Black, Hispanic, and of lower-income. Nonelective admissions were associated with longer lengths of stay (incidence rate ratio 1.46; 95% CI: 1.37-1.55), independent of child age, sex, neighborhood income, insurance, admission day, chronic conditions, and location. Nonelective admissions were associated with lower odds of feeding tube placement compared to elective admissions (adjusted odds ratio 0.62; 0.56-0.68). In the stratified analyses, children of racial and ethnic minority groups admitted nonelectively versus electively had relatively higher odds of feeding tube placement, while White children had relatively lower odds of feeding tube placement. CONCLUSION There are various sociodemographic differences between elective and nonelective FTT admissions. Future research is warranted to elucidate drivers of these differences, particularly those related to racial and ethnic disparities and structural racism.
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Affiliation(s)
- Allison J. Wu
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA, USA
| | - Nan Du
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA, USA
| | - Thomas Yen-Ting Chen
- Department of Medical Research & Education, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Lauren Fiechtner
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA
- Division of Gastroenterology and Nutrition, Massachusetts General Hospital for Children, Boston, MA, USA
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Khalid SI, Hunter BM, Shah P, Patel A, Thomson KB, LoPresti MA, Roblin DW, Lam S, Mehta AI. The Impact of Social Determinants of Health in Pediatric Shunted Hydrocephalus. Neurosurgery 2023; 92:1066-1072. [PMID: 36749102 DOI: 10.1227/neu.0000000000002333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/27/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Social risk factors have been shown to negatively affect health outcomes in children. However, this has not been characterized regarding pediatric shunted hydrocephalus. OBJECTIVE To explore the impact of social risk factors on outcomes in pediatric shunted hydrocephalus with the goal of identifying specific areas of intervention that might improve the outcomes of children undergoing cerebrospinal fluid (CSF) diversion. METHODS In an all-payer administrative database, records between January 2010 and October 2020 were analyzed to identify children undergoing CSF shunting procedures. Children with social risk factors were compared with those without regarding rates of infection, shunt-related interventions, and mortality within 5 years of their shunting procedure. RESULTS Among the 5420 children who underwent first-time shunting procedures, 263 (4.9%) were identified to have social risk factors. Children with identified social risk factors had increased odds of central nervous system infection (odds ratio [OR] 2.06, 95% CI 1.45-2.91), revision (OR 2.43, 95% I 1.89-3.12), and mortality (OR 2.86, 95% CI 1.23-5.72). The mean numbers of computed tomography studies (14.60 ± 17.78 vs 6.34 ± 6.10), MRI studies (18.76 ± 24.37 vs 7.88 ± 24.37), and shunt series X-rays (17.22 ± 19.04 vs 7.66 ± 8.54) were increased among children with social risk factors. CONCLUSION Children with social risk factors had increased rates of central nervous system infection, shunt-related interventions, and mortality within 5 years of CSF shunting. We underscore the importance of characterizing the impact of social risk factors in specific conditions, such as pediatric shunted hydrocephalus, and look to future directions aimed to mitigate these risk factors with coordination and direction of individualized resources, encouragement of advocacy, and community partnership.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Brittany M Hunter
- Division of Hospital-Based Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Pal Shah
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Aashka Patel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kyle B Thomson
- Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois, USA
| | - Melissa A LoPresti
- Department of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Douglas W Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente, Rockville, Maryland, USA
| | - Sandi Lam
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
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Sauers-Ford H, Schondelmeyer A, Shah A. What Should Hospitalists Consider in Addressing Social Determinants of Health? Hosp Pediatr 2023; 13:e40-e42. [PMID: 36594220 DOI: 10.1542/hpeds.2022-006959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
| | - Amanda Schondelmeyer
- Division of Hospital Medicine, and.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Anita Shah
- Division of Hospital Medicine, and.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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Lopez KN, Fuentes-Afflick E. Engaging Pediatric Subspecialists in Pursuit of Health Equity-Breaking Out of the Silo. JAMA Pediatr 2022; 176:841-842. [PMID: 35849417 DOI: 10.1001/jamapediatrics.2022.2420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Keila N Lopez
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Elena Fuentes-Afflick
- Department of Pediatrics, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco
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Hampton LL, DeBoy JT, Hornik CP, White MJ, Nazareth-Pidgeon KM. Association of Sociodemographic Factors With Reported Penicillin Allergy in Pediatric Inpatients. Hosp Pediatr 2022; 12:625-631. [PMID: 35660855 DOI: 10.1542/hpeds.2021-006462] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Characterize the association of sociodemographic factors with reported penicillin allergy in pediatric inpatients. METHODS We conducted a retrospective cohort study of pediatric inpatients admitted to general pediatric units at an academic medical center with reported penicillin allergy and reaction history. Sociodemographic factors evaluated were gender, age, race, ethnicity, language, and insurance payer. We conducted univariable and multivariable logistic regression models to evaluate associations between demographic variables and penicillin allergy. RESULTS Of 3890 pediatric inpatients, 299 (7.7%) had a reported penicillin allergy. The majority of documented reaction histories were hives, rash, or unknown. In univariable analysis, odds of penicillin allergy were lower in patients who identify as Black and who prefer a language other than English, and higher in patients of non-Hispanic/Latino ethnicity, those with private insurance, and with increasing age. In multivariable logistic regression, only Black race (adjusted odds ratio 0.42, 95% confidence interval CI 0.30-0.59) and young age were significantly associated with lower odds of penicillin allergy. CONCLUSIONS After adjustment for covariates, Black race was associated with lower odds of reported penicillin allergy in hospitalized children. Penicillin allergy reporting may be an indicator of racial differences in the prescribing of antimicrobial agents, patient-clinician communication, and access to health care.
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Affiliation(s)
- Laura L Hampton
- Division of Hospital Medicine, Department of Pediatrics, and
| | - Jason T DeBoy
- Management Engineer Team, Department of Performance Services; and
| | - Christoph P Hornik
- Department of Pediatrics, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
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Bhatt P, Parmar N, Ayensu M, Umscheid J, Vasudeva R, Donda K, Doshi H, Dapaah-Siakwan F. Trends and Resource Use for Kernicterus Hospitalizations in the United States. Hosp Pediatr 2022; 12:e185-e190. [PMID: 35578911 DOI: 10.1542/hpeds.2021-006502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the trends in hospitalization for kernicterus in the United States from 2006 through 2016. METHOD Repeated, cross-sectional analysis of the 2006 to 2016 editions of the Kids' Inpatient Database. All neonatal hospitalizations with an International Classification of Diseases, Ninth or Tenth Revision, Clinical Modification code for kernicterus and admitted at age ≤28 days were included. RESULTS Among 16 094 653 neonatal hospitalizations from 2006 to 2016, 20.5% were diagnosed with jaundice with overall incidence of kernicterus 0.5 per 100 000. The rate of kernicterus (per 100 000) was higher among males (0.59), Asian or Pacific Islanders (1.04), and urban teaching hospitals (0.72). Between 2006 and 2016, the incidence of kernicterus decreased from 0.7 to 0.2 per 100 000 (P-trend = .03). The overall median length of stay for kernicterus was 5 days (interquartile range [IQR], 3-8 days). The overall median inflation-adjusted cost of hospitalization was $5470 (IQR, $1609-$19 989). CONCLUSIONS Although the incidence of kernicterus decreased between 2006 and 2016, its continued occurrence at a higher rate among Asian or Pacific Islander and Black race or ethnicity in the United States require further probing. Multipronged approach including designating kernicterus as a reportable event, strengthening newborn hyperbilirubinemia care practices and bilirubin surveillance, parental empowerment, and removing barriers to care can potentially decrease the rate of kernicterus further.
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Affiliation(s)
- Parth Bhatt
- Department of Pediatrics, United Hospital Center, Bridgeport, West Virginia
| | - Narendrasinh Parmar
- Department of Pediatrics, Brookdale University Hospital and Medical Center, Brooklyn, New York
| | - Marian Ayensu
- Outpatient Department, The Trust Hospital, Accra, Ghana
| | - Jacob Umscheid
- Department of Pediatrics, University of Kansas School of Medicine, Wichita, Kansas
| | - Rhythm Vasudeva
- Department of Pediatrics, University of Kansas School of Medicine, Wichita, Kansas
| | - Keyur Donda
- Section of Neonatology, Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Harshit Doshi
- Neonatal Intensive Care Unit, Golisano Children's hospital of Southwest Florida, Fort Myers, Florida
| | - Fredrick Dapaah-Siakwan
- Neonatal Intensive Care Unit, Department of Medicine, Valley Children's Hospital, Madera, California
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Li J, Ramgopal S, Marin JR. Racial and ethnic differences in low-value pediatric emergency care. Acad Emerg Med 2022; 29:698-709. [PMID: 35212440 DOI: 10.1111/acem.14468] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/28/2021] [Accepted: 01/06/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Disparities in health care quality frequently focus on underuse. We evaluated racial/ethnic differences in low-value services delivered in the pediatric emergency department (ED). METHODS We performed a retrospective cross-sectional study of low-value services in children discharged from 39 pediatric EDs from January 2018 to December 2019 using the Pediatric Hospital Information System. Our primary outcome was receipt of one of 12 low-value services across nine conditions, including chest radiography in asthma and bronchiolitis; beta-agonist and corticosteroids in bronchiolitis; laboratory testing and neuroimaging in febrile seizure; neuroimaging in afebrile seizure; head injury and headache; and any imaging in sinusitis, constipation, and facial trauma. We analyzed the association of race/ethnicity on receipt of low-value services using generalized linear mixed models adjusted for age, sex, weekend, hour of presentation, payment, year, household income, and distance from hospital. RESULTS We included 4,676,802 patients. Compared with non-Hispanic White (NHW) patients, non-Hispanic Black (NHB) and Hispanic patients had lower adjusted odds (aOR [95% confidence interval]) of receiving imaging for asthma (0.60 [0.56 to 0.63] NHB; 0.84 [0.79 to 0.89] Hispanic), bronchiolitis (0.84 [0.79 to 0.89] NHB; 0.93 [0.88 to 0.99] Hispanic), head injury (0.84 [0.80 to 0.88] NHB; 0.80 [0.76 to 0.84] Hispanic), headache (0.67 [0.63 to 0.72] NHB; 0.83 [0.78 to 0.88] Hispanic), and constipation (0.71 [0.67 to 0.74] NHB; 0.76 [0.72 to 0.80] Hispanic). NHB patients had lower odds (95% CI) of receiving imaging for afebrile seizures (0.89 [0.8 to 1.0]) and facial trauma (0.69 [0.60 to 0.80]). Hispanic patients had lower odds (95% CI) of imaging (0.57 [0.36 to 0.90]) and blood testing (0.82 [0.69 to 0.98]) for febrile seizures. NHB patients had higher odds (95% CI) of receiving steroids (1.11 [1.00 to 1.21]) and beta-agonists (1.38 [1.24 to 1.54]) for bronchiolitis compared with NHW patients. CONCLUSIONS NHW patients more frequently receive low-value imaging while NHB patients more frequently receive low-value medications for bronchiolitis. Our study demonstrates the differences in care across race and ethnicity extend to many services, including those of low value. These findings highlight the importance of greater understanding of the complex interaction of race and ethnicity with clinical practice.
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Affiliation(s)
- Joyce Li
- Division of Emergency Medicine, Boston Children's Hospital Harvard Medical School Boston Massachusetts USA
| | - Sriram Ramgopal
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Jennifer R. Marin
- Division of Pediatric Emergency Medicine UPMC Children's Hospital of Pittsburgh University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
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Affiliation(s)
- JoAnna K Leyenaar
- Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
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35
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Shapiro MH, Goodman DM, Rodriguez VA. The Perfect Discharge: A Framework for High-Quality Hospital Discharges. Hosp Pediatr 2022; 12:108-117. [PMID: 34961884 DOI: 10.1542/hpeds.2021-006100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Matthew H Shapiro
- Department of Pediatrics, School of Medicine, University of California, Irvine, Irvine, California.,Children's Hospital of Orange County, Orange, California
| | - Denise M Goodman
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Victoria A Rodriguez
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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36
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Olszewski AE, Adiele A, Patneaude A, Zerr DM, Kett JC. The Health Equity Impact Assessment: A Case Study in COVID-19 Visitor Policy. Hosp Pediatr 2021:hpeds.2021-006128. [PMID: 34737217 DOI: 10.1542/hpeds.2021-006128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Aleksandra E Olszewski
- Division of Critical Care Medicine, Department of Pediatrics, McGaw Medical Center, Northwestern University and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Alicia Adiele
- Center for Diversity and Health Equity, Seattle Children's Hospital, Seattle, Washington
| | | | - Danielle M Zerr
- Infectious Diseases, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
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Vaz LE, Wagner DV, Ramsey KL, Jenisch C, Austin JP, Jungbauer RM, Felder K, Vega-Juarez R, Gomez M, Koskela-Staples N, Harris MA, Zuckerman KE. Identification of Caregiver-Reported Social Risk Factors in Hospitalized Children. Hosp Pediatr 2021; 10:20-28. [PMID: 31871220 DOI: 10.1542/hpeds.2019-0206] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Although health systems are increasingly moving toward addressing social determinants of health, social risk screening for hospitalized children is largely unexplored. We sought to determine if inpatient screening was feasible and describe the prevalence of social risk among children and caregivers, with special attention given to children with chronic conditions. METHODS Caregivers of pediatric patients on the hospitalist service at a children's hospital in the Pacific Northwest completed a social risk survey in 2017. This survey was used to capture items related to caregiver demographics; socioeconomic, psychosocial, and household risks; and adverse childhood experiences (ACEs). Charts were reviewed for child demographics and medical complexity. Results were tabulated as frequency distributions, and analyses compared the association of risk factors with a child's medical complexity by using χ2 tests. RESULTS A total of 265 out of 304 (87%) caregivers consented to participate. One in 3 families endorsed markers of financial stress (eg, difficulty paying for food, rent, or utilities). Forty percent experienced medical bill or insurance troubles. Caregiver mental health concerns were prevalent, affecting over one-third of all respondents. ACEs were also common, with 38% of children having at least 1 ACE. The presence of any ACE was more likely for children with chronic conditions than those without. CONCLUSIONS We found that social risk screening in the inpatient setting was feasible; social risk was uniformly common and did not disproportionately affect those with chronic diseases. Knowing the prevalence of social risk may assist in appropriate alignment of interventions tiered by social complexity.
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Affiliation(s)
- Louise E Vaz
- Department of Pediatrics, Doernbecher Children's Hospital,
| | - David V Wagner
- Department of Pediatrics, Doernbecher Children's Hospital
| | | | | | - Jared P Austin
- Department of Pediatrics, Doernbecher Children's Hospital
| | - Rebecca M Jungbauer
- Pacific Northwest Evidence-Based Practice Center, Oregon Health and Science University, Portland, Oregon
| | | | - Raul Vega-Juarez
- Department of Pediatrics, Doernbecher Children's Hospital.,Build Exito Program, Portland State University, Portland, Oregon; and
| | - Mauricio Gomez
- Department of Pediatrics, Doernbecher Children's Hospital
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Uppuluri S, Uppuluri A, Zarbin MA, Bhagat N. Epidemiology of Pediatric Open Globe Injury in the United States. J Pediatr Ophthalmol Strabismus 2021; 58:232-239. [PMID: 34288774 DOI: 10.3928/01913913-20210224-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To use the National Inpatient Sample (NIS) Database to describe trends in demographics, types, and incidence of pediatric open globe injuries in the United States. METHODS A retrospective, cross-sectional, observational study was conducted of 8,943 acute cases of pediatric open globe injury (age < 21 years) obtained from the NIS Database, between 2002 and 2014. Weighted analysis was performed using IBM SPSS Statistics 25 software (IBM Corporation). Codes from the International Classification of Disease, Ninth Revision, Clinical Modification were used to identify pediatric open globe injury cases. RESULTS In the United States, 8,943 pediatric cases of acute open globe injuries were identified between 2002 and 2014. Males comprised 78% of the acute pediatric open globe injury cases. Penetrating open globe injuries without intraocular foreign bodies (IOFBs) were the most common type of injury (P < .001). The proportion of injuries that were penetrating open globe injuries decreased with age, whereas the proportion of IOFBs and globe ruptures increased. The proportion of open globe injuries with IOFB in boys was twice as high as in girls. The incidence of open globe injuries by age, race, and gender was highest in the 16 to 20 years age group, in Blacks and Native Americans, and in boys, respectively. CONCLUSIONS The incidence of open globe injuries in pediatric patients (age < 21 years) was estimated to be 7.93 per 1,000,000 individuals and varied by race, gender, and age. The proportion of different types of open globe injury varied significantly by age, race, and gender. The mean duration of hospital stay for open globe injury management was 2.2 days, and 17.5% of patients lacked medical insurance. [J Pediatr Ophthalmol Strabismus. 2021;58(4):232-239.].
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Masciale M, Lopez MA, Yu X, Domínguez J, Fredricks K, Haq H, Raphael JL, Bocchini C. Public Benefit Use and Social Needs in Hospitalized Children With Undocumented Parents. Pediatrics 2021; 148:peds.2020-021113. [PMID: 34112659 DOI: 10.1542/peds.2020-021113] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Studies supporta recent decline in public benefit enrollment among immigrant families. We aimed to describe health and resource use, barriers to use, and immigration-related fear in families with undocumented parents compared with families without undocumented parents. We also aimed to assess associations with discontinuation of public benefits and fear of deportation. METHODS We assessed immigration concerns and enrollment in Medicaid, Supplemental Nutrition Assistance Program (SNAP), and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) with an 89-item anonymous, cross-sectional survey of English- and Spanish-speaking caregivers of hospitalized children. Multivariable logistic regression was used to assess associations with discontinuation of public benefits and fear of deportation. RESULTS Of 527 families approached, 399 enrolled (105 with 1 or more undocumented parent, 275 with no undocumented parent, and 19 with undisclosed immigration status). Compared with families without undocumented parents, families with undocumented parents had higher levels of poverty and food insecurity. Controlling for perceived eligibility, public benefit use was similar across groups. Of families with undocumented parents, 29% reported public benefit discontinuation because of immigration concerns, and 71% reported fear of deportation. Having an undocumented parent was associated with public benefit disenrollment (odds ratio: 46.7; 95% confidence interval: 5.9-370.4) and fear of deportation (odds ratio: 24.3; 95% confidence interval: 9.6-61.9). CONCLUSIONS Although families with undocumented parents had higher levels of poverty and food insecurity compared with families without undocumented parents, public benefit use was similar between groups. Immigration-related fear may be a barrier to public benefit use in this population.
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Affiliation(s)
- Marina Masciale
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Michelle A Lopez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Center for Child Health Policy and Advocacy, Texas Children's Hospital, Houston, Texas
| | - Xian Yu
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - José Domínguez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Karla Fredricks
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Heather Haq
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Jean L Raphael
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Center for Child Health Policy and Advocacy, Texas Children's Hospital, Houston, Texas
| | - Claire Bocchini
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas.,Center for Child Health Policy and Advocacy, Texas Children's Hospital, Houston, Texas
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Javalkar K, Robson VK, Gaffney L, Bohling AM, Arya P, Servattalab S, Roberts JE, Campbell JI, Sekhavat S, Newburger JW, de Ferranti SD, Baker AL, Lee PY, Day-Lewis M, Bucholz E, Kobayashi R, Son MB, Henderson LA, Kheir JN, Friedman KG, Dionne A. Socioeconomic and Racial and/or Ethnic Disparities in Multisystem Inflammatory Syndrome. Pediatrics 2021; 147:peds.2020-039933. [PMID: 33602802 PMCID: PMC8086000 DOI: 10.1542/peds.2020-039933] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To characterize the socioeconomic and racial and/or ethnic disparities impacting the diagnosis and outcomes of multisystem inflammatory syndrome in children (MIS-C). METHODS This multicenter retrospective case-control study was conducted at 3 academic centers from January 1 to September 1, 2020. Children with MIS-C were compared with 5 control groups: children with coronavirus disease 2019, children evaluated for MIS-C who did not meet case patient criteria, children hospitalized with febrile illness, children with Kawasaki disease, and children in Massachusetts based on US census data. Neighborhood socioeconomic status (SES) and social vulnerability index (SVI) were measured via a census-based scoring system. Multivariable logistic regression was used to examine associations between SES, SVI, race and ethnicity, and MIS-C diagnosis and clinical severity as outcomes. RESULTS Among 43 patients with MIS-C, 19 (44%) were Hispanic, 11 (26%) were Black, and 12 (28%) were white; 22 (51%) were in the lowest quartile SES, and 23 (53%) were in the highest quartile SVI. SES and SVI were similar between patients with MIS-C and coronavirus disease 2019. In multivariable analysis, lowest SES quartile (odds ratio 2.2 [95% confidence interval 1.1-4.4]), highest SVI quartile (odds ratio 2.8 [95% confidence interval 1.5-5.1]), and racial and/or ethnic minority background were associated with MIS-C diagnosis. Neither SES, SVI, race, nor ethnicity were associated with disease severity. CONCLUSIONS Lower SES or higher SVI, Hispanic ethnicity, and Black race independently increased risk for MIS-C. Additional studies are required to target interventions to improve health equity for children.
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Affiliation(s)
- Karina Javalkar
- Departments of Medicine and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts;,Department of Pediatrics, Boston University, Boston, Massachusetts;,Contributed equally as co-first authors
| | - Victoria K. Robson
- Departments of Medicine and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts;,Department of Pediatrics, Boston University, Boston, Massachusetts;,Contributed equally as co-first authors
| | - Lukas Gaffney
- Departments of Medicine and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts;,Department of Pediatrics, Boston University, Boston, Massachusetts
| | - Amy M. Bohling
- Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Puneeta Arya
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts;,Division of Cardiology and
| | - Sarah Servattalab
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts;,Massachusetts General Hospital for Children, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Jordan E. Roberts
- Divisions of Immunology and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Jeffrey I. Campbell
- Infectious Diseases and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Sepehr Sekhavat
- Department of Pediatrics, Boston University, Boston, Massachusetts;,Department of Cardiology, Boston Medical Center, Boston, Massachusetts
| | - Jane W. Newburger
- Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Sarah D. de Ferranti
- Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Annette L. Baker
- Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Pui Y. Lee
- Divisions of Immunology and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Megan Day-Lewis
- Divisions of Immunology and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Emily Bucholz
- Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Ryan Kobayashi
- Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Mary Beth Son
- Divisions of Immunology and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Lauren A. Henderson
- Divisions of Immunology and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - John N. Kheir
- Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Kevin G. Friedman
- Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Audrey Dionne
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; .,Cardiology, Boston Children's Hospital, Boston, Massachusetts
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Addison J, Herrera N, Tuchman L, Bokor B. HEADSS Up! Missed Opportunity for Psychosocial Screening in Hospitalized Adolescents. Hosp Pediatr 2021; 11:417-421. [PMID: 33789962 DOI: 10.1542/hpeds.2020-000216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the frequency and completeness of adolescent psychosocial screening documentation for adolescents and young adults hospitalized to a pediatric hospitalist medicine service. METHODS All patients 12 to 21 years old on the hospital medicine service in an urban, academic, free standing children's hospital in the Mid-Atlantic United States from January 1, 2014, to December 31, 2015, were identified. A retrospective review was conducted to assess the frequency of documentation of a complete psychosocial screening using the Home, Education, Activities, Drugs, Sex, Suicide assessment within 48 hours of admission. Differences in screening rates according to race, sex, age, patient's medical complexity, and whether they required transfer to a higher level of care were assessed through logistic regression analyses. RESULTS Only 5.3% (24 of 435 patients) had all 6 domains of the Home, Education, Activities, Drugs, Sex, Suicide psychosocial assessment documented. Controlling for patient characteristics (demographic, medical complexity, and level of care), the odds of being screened for sensitive domains (drugs, sex, and suicide) were higher in female patients, patients ≥16 years old, and those transferred to a higher level of care. Those considered high medical complexity were screened less across all domains. CONCLUSIONS Overall, pediatric hospitalist documentation lacked adolescent psychosocial screening. Potential opportunities exist through screening early in the hospitalization to connect youth with services that influence health outcomes.
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Affiliation(s)
- Jessica Addison
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts;
| | - Nicole Herrera
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC; and
| | - Lisa Tuchman
- Division of Adolescent and Young Adult Medicine, Children's National Health System, Washington, DC
| | - Brooke Bokor
- Division of Adolescent and Young Adult Medicine, Children's National Health System, Washington, DC
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Masciale M, Dongarwar D, Salihu HM. Predictors of Prolonged Length of Stay in Suicidal Children Transferred to Psychiatric Facilities. Hosp Pediatr 2021; 11:366-373. [PMID: 33782014 DOI: 10.1542/hpeds.2020-001230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine if sociodemographic factors or underlying mental health conditions serve as predictors for prolonged length of stay (pLOS) in children hospitalized for suicidal ideation (SI) or suicide attempt (SA) requiring transfer to psychiatric facilities. We hypothesized an association between certain patient and hospital characteristics and pLOS. METHODS For this retrospective cross-sectional study, we used the National Inpatient Sample. We included children <18 years old hospitalized with a primary or secondary International Classification of Diseases, 10th Edition, Clinical Modification diagnosis of SI or SA who were dispositioned to psychiatric facilities from 2016 to 2017. Exposures were patient sociodemographics, underlying mental health diagnoses, and hospital characteristics. Our outcome was pLOS. Adjusted prevalence ratios with 95% confidence intervals (CIs) were generated with log binomial regression. RESULTS Of 12 715 hospitalizations meeting inclusion criteria, 5475 had pLOS. After adjusting for sociodemographics and hospital characteristics, predictive factors for pLOS were public insurance use (prevalence ratio: 1.40; CI: 1.12-1.78), urban nonteaching hospital location (prevalence ratio: 4.61; CI: 2.33-9.12), urban teaching hospital location (prevalence ratio: 3.26; CI: 1.84-5.76), and underlying diagnosis of mood disorder (prevalence ratio: 1.98; CI: 1.63-3.42). Hispanic patients had decreased probability of pLOS (prevalence ratio: 0.69; CI: 0.52-0.93). Otherwise, age, zip income, sex, and hospital region were not predictive of pLOS. CONCLUSIONS Among children hospitalized for SI or SA requiring transfer to psychiatric facilities, public insurance, urban hospital location, and diagnoses of mood disorder, depression, and bipolar disorder were predictive of pLOS. Further research is needed on how to decrease disparities in length of stay among this vulnerable population.
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Affiliation(s)
- Marina Masciale
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas; and
| | - Deepa Dongarwar
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
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Marin JR, Rodean J, Hall M, Alpern ER, Aronson PL, Chaudhari PP, Cohen E, Freedman SB, Morse RB, Peltz A, Samuels-Kalow M, Shah SS, Simon HK, Neuman MI. Racial and Ethnic Differences in Emergency Department Diagnostic Imaging at US Children's Hospitals, 2016-2019. JAMA Netw Open 2021; 4:e2033710. [PMID: 33512517 PMCID: PMC7846940 DOI: 10.1001/jamanetworkopen.2020.33710] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Diagnostic imaging is frequently performed as part of the emergency department (ED) evaluation of children. Whether imaging patterns differ by race and ethnicity is unknown. OBJECTIVE To evaluate racial and ethnic differences in the performance of common ED imaging studies and to examine patterns across diagnoses. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study evaluated visits by patients younger than 18 years to 44 US children's hospital EDs from January 1, 2016, through December 31, 2019. EXPOSURES Non-Hispanic Black and Hispanic compared with non-Hispanic White race/ethnicity. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of visits for each race/ethnicity group with at least 1 diagnostic imaging study, defined as plain radiography, computed tomography, ultrasonography, and magnetic resonance imaging. The major diagnostic categories classification system was used to examine race/ethnicity differences in imaging rates by diagnoses. RESULTS A total of 13 087 522 visits by 6 230 911 children and adolescents (mean [SD] age, 5.8 [5.2] years; 52.7% male) occurred during the study period. Diagnostic imaging was performed during 3 689 163 visits (28.2%). Imaging was performed in 33.5% of visits by non-Hispanic White patients compared with 24.1% of visits by non-Hispanic Black patients (odds ratio [OR], 0.60; 95% CI, 0.60-0.60) and 26.1% of visits by Hispanic patients (OR, 0.66; 95% CI, 0.66-0.67). Adjusting for confounders, visits by non-Hispanic Black (adjusted OR, 0.82; 95% CI, 0.82-0.83) and Hispanic (adjusted OR, 0.87; 95% CI, 0.87-0.87) patients were less likely to include any imaging study compared with visits by non-Hispanic White patients. Limiting the analysis to only visits by nonhospitalized patients, the adjusted OR for imaging was 0.79 (95% CI, 0.79-0.80) for visits by non-Hispanic Black patients and 0.84 (95% CI, 0.84-0.85) for visits by Hispanic patients. Results were consistent in analyses stratified by public and private insurance groups and did not materially differ by diagnostic category. CONCLUSIONS AND RELEVANCE In this study, non-Hispanic Black and Hispanic children were less likely to receive diagnostic imaging during ED visits compared with non-Hispanic White children. Further investigation is needed to understand and mitigate these potential disparities in health care delivery and to evaluate the effect of these differential imaging patterns on patient outcomes.
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Affiliation(s)
- Jennifer R. Marin
- Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Radiology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | - Elizabeth R. Alpern
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Paul L. Aronson
- Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Pradip P. Chaudhari
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Eyal Cohen
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Emergency Medicine, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rustin B. Morse
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Alon Peltz
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Samir S. Shah
- Divisions of Hospital Medicine and Infectious Diseases, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Harold K. Simon
- Division of Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Mark I. Neuman
- Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Shah AN, Auger KA, Sucharew HJ, Mangeot C, Childress K, Haney J, Shah SS, Simmons JM, Beck AF. Effect of Parental Adverse Childhood Experiences and Resilience on a Child's Healthcare Reutilization. J Hosp Med 2020; 15:645-651. [PMID: 32490805 PMCID: PMC7657653 DOI: 10.12788/jhm.3396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are associated with poor health outcomes in adults. Resilience may mitigate this effect. There is limited evidence regarding how parents' ACEs and resilience may be associated with their children's health outcomes. OBJECTIVE To determine the association of parental ACEs and resilience with their child's risk of unanticipated healthcare reutilization. DESIGN, SETTING, AND PARTICIPANTS We conducted a prospective cohort study (August 2015 to October 2016) at a tertiary, freestanding pediatric medical center in Cincinnati, Ohio. Eligible participants were English-speaking parents of children hospitalized on a Hospital Medicine or Complex Services team. A total of 1,320 parents of hospitalized children completed both the ACE questionnaire and the Brief Resilience Scale Survey. EXPOSURE Number of ACEs and Brief Resilience Scale Score among parents. MAIN OUTCOMES Unanticipated reutilization by children, defined as returning to the emergency room, urgent care, or being readmitted to the hospital within 30 days of hospital discharge. RESULTS In adjusted analyses, children of parents with 4 or more ACEs had 1.69-times higher odds (95% CI, 1.11-2.60) of unanticipated reutilization after an index hospitalization, compared with children of parents with no ACEs. Resilience was not significantly associated with reutilization. CONCLUSION Parental history of ACEs is strongly associated with higher odds of their child having unanticipated healthcare reutilization after a hospital discharge, highlighting an intergenerational effect. Screening may be an important tool for outcome prediction and intervention guidance following pediatric hospitalization.
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Affiliation(s)
- Anita N Shah
- Division of Hospital Medicine, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Mayerson Center for Safe and Healthy Children, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Corresponding Author: Anita Shah, DO, MPH; ; Telephone: 513-636-7994; Twitter @DrAnita_Shah
| | - Katherine A Auger
- Division of Hospital Medicine, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems System Excellence, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Heidi J Sucharew
- Biostatistics and Epidemiology, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Colleen Mangeot
- Biostatistics and Epidemiology, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kelsey Childress
- Division of Hospital Medicine, Department of Pediatrics, Kaiser South Sacramento, Sacramento, California
| | - Julianne Haney
- College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems System Excellence, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Infectious Diseases, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jeffrey M Simmons
- Division of Hospital Medicine, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems System Excellence, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew F Beck
- Division of Hospital Medicine, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center for Health Systems System Excellence, Cincinnnati Children’s Hospital Medical Center, Cincinnati, Ohio
- General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Bucholz EM, Schuster MA, Toomey SL. Trends in 30-Day Readmission for Medicaid and Privately Insured Pediatric Patients: 2010-2017. Pediatrics 2020; 146:peds.2020-0270. [PMID: 32611808 DOI: 10.1542/peds.2020-0270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Children insured by Medicaid have higher readmission rates than privately insured children. However, little is known about whether this disparity has changed over time. METHODS Data from the 2010 to 2017 Healthcare Cost and Utilization Project Nationwide Readmissions Database were used to compare trends in 30-day readmission rates for children insured by Medicaid and private insurers. Patient-level crude and risk-adjusted readmission rates were compared by using Poisson regression. Hospital-level risk-adjusted readmission rates were compared between Medicaid- and privately insured patients within a hospital by using linear regression. RESULTS Approximately 60% of pediatric admissions were covered by Medicaid. From 2010 to 2017, the percentage of children with a complex or chronic condition increased for both Medicaid- and privately insured patients. Readmission rates were consistently higher for Medicaid beneficiaries from 2010 to 2017. Readmission rates declined slightly for both Medicaid- and privately insured patients; however, they declined faster for privately insured patients (rate ratio: 0.988 [95% confidence interval: 0.986-0.989] vs 0.995 [95% confidence interval: 0.994-0.996], P for interaction <.001]). After adjustment, readmission rates for Medicaid- and privately insured patients declined at a similar rate (P for interaction = .87). Risk-adjusted hospital readmission rates were also consistently higher for Medicaid beneficiaries. The within-hospital difference in readmission rates for Medicaid versus privately insured patients remained stable over time (slope for difference: 0.015 [SE 0.011], P = .019). CONCLUSIONS Readmission rates for Medicaid- and privately insured pediatric patients declined slightly from 2010 to 2017 but remained substantially higher among Medicaid beneficiaries suggesting a persistence of the disparity by insurance status.
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Affiliation(s)
- Emily M Bucholz
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; .,Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Mark A Schuster
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts; and.,Bernard J. Tyson School of Medicine, Kaiser Permanente, Pasadena, California
| | - Sara L Toomey
- Harvard Medical School, Harvard University, Boston, Massachusetts.,Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts; and
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Vasan A, Kenyon CC, Palakshappa D. Differences in Pediatric Residents' Social Needs Screening Practices Across Health Care Settings. Hosp Pediatr 2020; 10:443-446. [PMID: 32350005 DOI: 10.1542/hpeds.2019-0286] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The American Academy of Pediatrics recommends that all pediatricians screen for social determinants of health to identify families in need and connect them to available resources. We examined pediatric residents' screening practices for social needs in different clinical settings and explored the influence of electronic health record (EHR) prompts on screening. METHODS In this cross-sectional study, pediatric residents participated in a brief electronic survey assessing (1) screening practices for unmet social needs and (2) perceived barriers to and facilitators of routine screening in the inpatient and outpatient settings. The differences in screening by care setting were assessed by using Fisher's exact test. Mixed-effects logistic regression was used to examine the association between EHR prompts and resident screening practices. RESULTS Ninety-two pediatric residents (64% of the residency program) responded to the survey. Respondents reported significantly higher rates of social needs screening in the outpatient as compared with the inpatient setting (98% vs 37%; P < .001). Residents cited time constraints, lack of knowledge about available resources, and discomfort with screening questions as barriers to screening in both settings. Residents were more likely to screen for social needs when screening questions were embedded in the EHR (odds ratio = 9.6; 95% confidence interval: 6.7-13.9). CONCLUSIONS Pediatric residents were more likely to screen for unmet social needs in the outpatient than in the inpatient setting despite reporting similar barriers to screening in both settings. EHR-based social needs screening templates could be used to increase rates of screening and reach additional families in need.
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Affiliation(s)
- Aditi Vasan
- National Clinician Scholars Program and .,PolicyLab and Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Chén C Kenyon
- PolicyLab and Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Deepak Palakshappa
- Division of Public Health Sciences and Departments of Internal Medicine and Pediatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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