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Child Opportunity Index 2.0 and acute care utilization among children with medical complexity
Cristin Q Fritz1, Matt Hall2, Jessica L Bettenhausen3
1Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Insights
Children with medical complexity living in low opportunity areas use more acute care. Targeted interventions in underserved communities can improve health outcomes for these children.
Area of Science:
- Pediatric Healthcare
- Social Determinants of Health
- Health Services Research
Background:
- Children with medical complexity (CMC) exhibit high acute care utilization.
- Patient-level social complexity is a known factor influencing healthcare needs.
- Understanding geographic variations in opportunity is crucial for addressing healthcare disparities.
Purpose of the Study:
- To investigate the association between ZIP code-level child opportunity and acute care utilization in CMC.
- To identify if socioeconomic factors at a community level impact healthcare access and needs for complex pediatric patients.
Main Methods:
- Cross-sectional, multicenter study using the Pediatric Health Information Systems database (2016-2019).
- Inclusion criteria: CMC aged 28 days to <16 years with an initial ED or inpatient encounter in 2016.
- Analysis of Child Opportunity Index 2.0 (COI) by ZIP code against total utilization days (hospital bed-days + ED encounters), adjusted for covariates.
Main Results:
- A total of 23,197 CMC were analyzed.
- Unadjusted analyses showed a stepwise decrease in utilization days from the lowest to highest COI quintiles (p < .001).
- Adjusted analyses revealed that CMC from the lowest COI quintile utilized care 1.22 times the rate of those from the highest COI quintile.
Conclusions:
- Children with medical complexity residing in lower opportunity ZIP codes experience higher acute care utilization.
- Community-based and hospital-led interventions in underserved areas may help reduce disparities and improve health outcomes for CMC.
- Addressing social determinants of health at the ZIP code level is essential for equitable pediatric care.
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.
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