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Accountable Care Organizations, Child Opportunity Index, and Complicated Appendicitis in Children
Shruthi Srinivas1, Brenna Rachwal1, Kristine L Griffin1
1Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio.
Insights
Lower Child Opportunity Index (COI) is linked to complicated appendicitis (CA) in children. Accountable care organization (ACO) enrollment did not alter this association, indicating a need for broader social determinant interventions.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Social Determinants of Health
Background:
- Child Opportunity Index (COI) is correlated with complicated appendicitis (CA) in pediatric populations.
- Accountable care organizations (ACOs) aim to improve care value, potentially influencing health outcome disparities.
- The impact of ACO enrollment on the COI-CA association in children requires investigation.
Purpose of the Study:
- To determine if enrollment in the Partners For Kids (PFK) ACO modifies the association between COI and CA in children.
- To analyze the relationship between socioeconomic factors, represented by COI, and the incidence of complicated appendicitis.
- To assess the role of value-based care models in mitigating health disparities related to appendicitis outcomes.
Main Methods:
- Retrospective review of 1337 children with public insurance undergoing appendectomy.
- Comparison of COI and clinical confounders between simple and complicated appendicitis cases.
- Multivariable logistic regression models were used to test for interaction between COI and PFK enrollment.
Main Results:
- Lower COI quintiles were significantly associated with an increased percentage of CA (P=0.01).
- PFK enrollment did not modify the association between COI and CA.
- Younger age and Very Low COI were independently associated with CA.
- PFK enrollment was associated with fewer 30-day readmissions compared to other public insurance.
Conclusions:
- The association between low socioeconomic opportunity and complicated appendicitis in children is not modified by ACO enrollment.
- ACOs alone may not be sufficient to address social determinants of health impacting pediatric appendicitis outcomes.
- Further strategies are needed to mitigate the influence of social determinants on health disparities in pediatric surgical care.
Introduction:
Child Opportunity Index (COI) is associated with complicated appendicitis (CA) in children. Value-based care through an accountable care organization (ACO) may modify this association. We aimed to determine if enrollment in our state's ACO, Partners For Kids (PFK), modified the association between COI and CA.
Methods:
Using a single-institution, retrospective review of children with public insurance undergoing appendectomy for acute appendicitis, COI and clinical confounders were compared by simple versus CA. Multivariable logistic regression models using COI, insurance, and age were fit with and without interaction terms to determine if PFK enrollment modified the association between COI and CA.
Results:
Among 1337 children, 31.0% had CA. Most (78.6%) were enrolled in PFK; this was not different between simple and CA. CA was associated with younger median age (7.0 y versus 8.0 y, P < 0.001). As overall COI quintile decreased (lower opportunity), the percentage of children with CA increased (P = 0.01). On multivariable regression controlling for age, PFK, and COI, only Very Low COI and age remained significantly associated with CA. The association between COI and CA was not modified by PFK enrollment. COI and PFK enrollment were not associated with postoperative complications, except children with PFK had fewer 30-d readmissions (4.2% versus 14.6%, P < 0.001) compared to those with other public insurance.
Conclusions:
Low COI was associated with higher CA, and this association was not modified by enrollment in an ACO, suggesting that ACO enrollment alone may not be sufficient in addressing social determinants of health among children with CA.
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