Child Opportunity Index 2.0 and acute care utilization among children with medical complexity.
Journal
Journal of hospital medicine
ISSN: 1553-5606
Titre abrégé: J Hosp Med
Pays: United States
ID NLM: 101271025
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
revised:
24
01
2022
received:
20
11
2021
accepted:
28
01
2022
entrez:
10
5
2022
pubmed:
11
5
2022
medline:
12
5
2022
Statut:
ppublish
Résumé
Disproportionately high acute care utilization among children with medical complexity (CMC) is influenced by patient-level social complexity. The objective of this study was to determine associations between ZIP code-level opportunity and acute care utilization among CMC. This cross-sectional, multicenter study used the Pediatric Health Information Systems database, identifying encounters between 2016-2019. CMC aged 28 days to <16 years with an initial emergency department (ED) encounter or inpatient/observation admission in 2016 were included in primary analyses. We assessed associations between the nationally-normed, multi-dimensional, ZIP code-level Child Opportunity Index 2.0 (COI) (high COI = greater opportunity), and total utilization days (hospital bed-days + ED discharge encounters). Analyses were conducted using negative binomial generalized estimating equations, adjusting for age and distance from hospital and clustered by hospital. Secondary outcomes included intensive care unit (ICU) days and cost of care. A total of 23,197 CMC were included in primary analyses. In unadjusted analyses, utilization days decreased in a stepwise fashion from 47.1 (95% confidence interval: 45.5, 48.7) days in the lowest COI quintile to 38.6 (36.9, 40.4) days in the highest quintile (p < .001). The same trend was present across all outcome measures, though was not significant for ICU days. In adjusted analyses, patients from the lowest COI quintile utilized care at 1.22-times the rate of those from the highest COI quintile (1.17, 1.27). CMC from low opportunity ZIP codes utilize more acute care. They may benefit from hospital and community-based interventions aimed at equitably improving child health outcomes.
Sections du résumé
BACKGROUND
Disproportionately high acute care utilization among children with medical complexity (CMC) is influenced by patient-level social complexity.
OBJECTIVE
The objective of this study was to determine associations between ZIP code-level opportunity and acute care utilization among CMC.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional, multicenter study used the Pediatric Health Information Systems database, identifying encounters between 2016-2019. CMC aged 28 days to <16 years with an initial emergency department (ED) encounter or inpatient/observation admission in 2016 were included in primary analyses.
MAIN OUTCOME AND MEASURES
We assessed associations between the nationally-normed, multi-dimensional, ZIP code-level Child Opportunity Index 2.0 (COI) (high COI = greater opportunity), and total utilization days (hospital bed-days + ED discharge encounters). Analyses were conducted using negative binomial generalized estimating equations, adjusting for age and distance from hospital and clustered by hospital. Secondary outcomes included intensive care unit (ICU) days and cost of care.
RESULTS
A total of 23,197 CMC were included in primary analyses. In unadjusted analyses, utilization days decreased in a stepwise fashion from 47.1 (95% confidence interval: 45.5, 48.7) days in the lowest COI quintile to 38.6 (36.9, 40.4) days in the highest quintile (p < .001). The same trend was present across all outcome measures, though was not significant for ICU days. In adjusted analyses, patients from the lowest COI quintile utilized care at 1.22-times the rate of those from the highest COI quintile (1.17, 1.27).
CONCLUSIONS
CMC from low opportunity ZIP codes utilize more acute care. They may benefit from hospital and community-based interventions aimed at equitably improving child health outcomes.
Identifiants
pubmed: 35535923
doi: 10.1002/jhm.12810
pmc: PMC9254633
mid: NIHMS1819717
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
243-251Subventions
Organisme : AHRQ HHS
ID : T32 HS026122
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022 Society of Hospital Medicine.
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