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Hospital Admissions in Pediatric Patients With Tracheostomies Based on Rurality and Insurance Status
Adam J Van Horn1, Raquel Good2, Aaron L Thatcher3
1Department of Surgery, Division of Otolaryngology, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA.
Insights
Readmission after pediatric tracheostomy is less common in rural patients but more common in publicly insured patients. These findings aid in identifying children who may need extra support during discharge and follow-up care.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Healthcare Disparities
Background:
- Pediatric tracheostomy is a critical intervention for airway management.
- Understanding factors influencing readmission is crucial for optimizing patient outcomes.
- Rurality and public insurance status are potential social determinants of health impacting pediatric care.
Purpose of the Study:
- To investigate the association between rurality and public insurance status with 30-day readmission rates in pediatric patients following tracheostomy.
- To identify patient subgroups at higher risk for readmission after tracheostomy.
Main Methods:
- Retrospective cohort study utilizing the Pediatric Health Information System (PHIS) Database (2013-2017).
- Defined rural status using rural-urban commuting area codes and insurance status by primary payer.
- Analyzed all-cause and tracheostomy-related 30-day readmissions using multivariate logistic regression.
Main Results:
- Rural patients showed lower odds of 30-day readmission (OR: 0.80, CI: 0.68-0.95).
- Publicly insured patients had higher odds of 30-day readmission (OR: 1.24, CI: 1.09-1.42) and tracheostomy-related readmission (OR: 1.39, CI: 1.03-1.88).
- No significant association was found between rurality and insurance status.
Conclusions:
- Publicly insured pediatric patients are at increased risk for 30-day readmission post-tracheostomy.
- Rural pediatric patients demonstrated a lower likelihood of 30-day readmission.
- Findings highlight the need for targeted discharge planning and follow-up for vulnerable pediatric populations.
Objective:
Determine whether rurality or public insurance status is associated with greater 30-day readmission after tracheostomy in pediatric patients.
Study Design:
Retrospective cohort.
Setting:
Pediatric Health Information System (PHIS) Database.
Methods:
Patients within PHIS who underwent tracheostomy from 2013 to 2017 were included. Rural status was defined by rural-urban commuting area codes. Insurance status was based on the primary payer. All-cause 30-day readmissions and tracheostomy-related readmissions were recorded. Multivariate logistic regression was performed to test for differences in readmissions between cohorts.
Results:
Among patients, 1092 were rural, and 4329 were publicly insured, with no significant association between rurality and insurance. Compared to nonrural patients, rural patients were more frequently white, less frequently ventilator dependent, and more likely discharged home rather than to a care facility. Publicly insured patients were more frequently non-white. Twenty-eight percent of patients were readmitted within 30 days of discharge. Odds of 30-day readmission were lower in rural patients (odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.68-0.95, p = .01) but higher in publicly insured (OR: 1.24, 95% CI: 1.09-1.42, p = .001) controlling for age at tracheostomy, sex, race, and ventilator dependence. The odds of tracheostomy-related admission did not differ by rurality but were higher in publicly insured children (1.39, 95% CI: 1.03-1.88, p = .03).
Conclusion:
Readmission within 30 days following tracheostomy was more likely in publicly insured patients and less likely in rural patients. These findings help identify at-risk patients when considering discharge planning and follow-up. More work is needed to understand long-term tracheostomy outcomes in these groups.
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