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The Role of Caregiver-Reported Risks in Predicting Adverse Pediatric Outcomes
Louise E Vaz1, David V Wagner1, Rebecca M Jungbauer2
1Department of Pediatrics, Doernbecher Children's Hospital.
Insights
Caregiver reports of poor child health, high care needs, and difficulty accessing care predict future health events in hospitalized children. These insights can guide interventions for better pediatric health outcomes.
Area of Science:
- Pediatric Health Outcomes
- Social Determinants of Health
- Healthcare Disparities
Background:
- Social risk factors significantly impact pediatric health but their specific relevance during inpatient admissions is understudied.
- Understanding these factors is crucial for predicting and mitigating future health complications in children.
Purpose of the Study:
- To examine associations between caregiver-reported social and medical factors and subsequent health complications in hospitalized children.
- To identify key risk factors that predict acute events within 90 days post-discharge.
Main Methods:
- A predischarge questionnaire captured social and medical risk factors from caregivers of 249 hospitalized children.
- Electronic health records provided demographic data, chronic disease status, and 90-day post-discharge acute events.
- Logistic regression analysis, including adjusted odds ratios (aOR), was used to determine associations between risk factors and event presence.
Main Results:
- 33% of children experienced at least one acute event (e.g., emergency department visit, readmission) within 90 days.
- Caregiver perception of poor child health prior to discharge was strongly associated with future events (aOR = 4.7).
- High care coordination needs (aOR = 3.2) and difficulty accessing care coordination (aOR = 2.5) were also significant predictors of acute events.
Conclusions:
- Caregiver-reported social and medical risks offer valuable predictive information beyond electronic health records.
- Identifying these risks can inform targeted interventions to improve health outcomes for hospitalized children.
- Addressing care coordination challenges is vital for reducing readmissions and emergency visits.
Objective:
Certain social risk factors (e.g., housing instability, food insecurity) have been shown to directly and indirectly influence pediatric health outcomes; however, there is limited understanding of which social factors are most salient for children admitted to the hospital. This study examines how caregiver-reported social and medical characteristics of children experiencing an inpatient admission are associated with the presence of future health complications.
Methods:
Caregivers of children experiencing an inpatient admission (N = 249) completed a predischarge questionnaire designed to capture medical and social risk factors across systems (e.g., patient, caregiver, family, community, healthcare environment). Electronic health record (EHR) data were reviewed for child demographic data, chronic disease status, and subsequent emergency department visits or readmissions (i.e., acute events) 90 days postindex hospitalization. Associations between risk factors and event presence were estimated using odds ratios (ORs) and confidence intervals (CI), both unadjusted and adjusted OR (aOR) for chronic disease and age.
Results:
Thirty-three percent (N = 82) of children experienced at least one event. After accounting for child age and chronic disease status, caregiver perceptions of child's health being generally "poor" or "not good" prior to discharge (aOR = 4.7, 95% CI = 2.3, 9.7), having high care coordination needs (aOR = 3.2, 95% CI = 1.6, 6.1), and experiencing difficulty accessing care coordination (aOR = 2.5, 95% CI = 1.4, 4.7) were significantly associated with return events.
Conclusions:
Caregiver report of risks may provide valuable information above and beyond EHR records to both determine risk of future health problems and inform intervention development.
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