1
|
Fritz CQ, Fleegler EW, DeSouza H, Richardson T, Kaiser SV, Sills MR, Cooper JN, Parikh K, Puls HT, DeLaroche AM, Hogan AH, Pantell MS, Kornblith AE, Heller KR, Bigham MT, Goyal M. Child Opportunity Index and Changes in Pediatric Acute Care Utilization in the COVID-19 Pandemic. Pediatrics 2022; 149:185223. [PMID: 35233618 DOI: 10.1542/peds.2021-053706] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Pediatric acute care utilization decreased dramatically during the coronavirus disease 2019 (COVID-19) pandemic. This study examined the association between the Child Opportunity Index (COI), a multidimensional neighborhood measure of childhood opportunity, and changes in acute care utilization at US pediatric hospitals during the COVID-19 pandemic compared with the previous 3 years. METHODS This observational study used administrative data across 41 US-based pediatric hospitals. Children aged 0 to 17 years with emergency department (ED) encounters during the study period were included. The COVID-19 pandemic time period (March 15, 2020-March 14, 2021) was the primary exposure. The primary outcome was the relative volume drop in ED encounters and observation/inpatient admissions through the ED by COI quintile. RESULTS Of 12 138 750 encounters, 3 705 320 (30.5%) were among the very low COI quintile. Overall, there was a 46.8% relative volume reduction in the pandemic period compared with the prepandmic period. This drop in volume occurred disproportionately among the very low COI quintile (51.1%) compared with the very high COI quintile (42.8%). The majority of clinical diagnosis groups demonstrated larger relative volume drops among the very low COI quintile. CONCLUSIONS Acute care utilization decreased the most among children from very low COI neighborhoods, narrowing previously described acute care utilization disparities. Additional study of patient perspectives on health care needs and access during this period is required to understand these changes.
Collapse
Affiliation(s)
- Cristin Q Fritz
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric W Fleegler
- Department of Pediatrics, Boston Children's Hospitaland Harvard Medical School, Boston, Massachusetts
| | | | | | - Sunitha V Kaiser
- Departments of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco, California.,Philip R. Lee Institute of Health Policy Studies, San Francisco, California
| | - Marion R Sills
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Colorado, Aurora, Colorado
| | | | - Kavita Parikh
- Department of Pediatrics, Children's National Hospitaland The George Washington University, Washington, District of Columbia
| | - Henry T Puls
- Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Amy M DeLaroche
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan
| | - Alex H Hogan
- Division of Hospital Medicine, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Matthew S Pantell
- Department of Pediatric Hospital Medicine, University of California, San Francisco, California
| | - Aaron E Kornblith
- Division of Emergency Medicine, Department of Pediatrics, University of California, San Francisco, California
| | - Kayla R Heller
- Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Michael T Bigham
- Department of Pediatrics, Akron Children's Hospital, Akron, Ohio
| | - Monika Goyal
- Department of Pediatrics, Children's National Hospitaland The George Washington University, Washington, District of Columbia
| |
Collapse
|