Related Experiment Video
Updated: May 16, 2025
Author Spotlight: Assessing the Feasibility of Using Amplitude-Integrated EEG During Neonatal Transport
Published on: June 21, 2024
Illustrating the Role of Infant Well-Child Visits in the Association Between Transportation Insecurity and Acute
Jewel Park1, Michelle Gorecki2, Aaron Flicker3
1Pediatric Residency Program (J Park), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Transportation insecurity in infants is linked to fewer well-child visits (WCVs). However, WCV attendance did not mediate the relationship between transportation insecurity and acute healthcare use. Further research is needed to understand these links.
Area of Science:
- Pediatric Health
- Health Services Research
- Social Determinants of Health
Background:
- Transportation insecurity is a significant social determinant of health affecting access to care.
- Well-child visits (WCVs) are crucial for monitoring infant health and development.
- Understanding the role of WCVs in mitigating health disparities is essential.
Purpose of the Study:
- To investigate if well-child visits (WCVs) mediate the association between transportation insecurity and acute healthcare utilization in infants.
- To analyze the impact of transportation insecurity on WCV attendance and subsequent healthcare needs.
Main Methods:
- Retrospective cohort study of 4114 infants followed for 15 months.
- Assessed transportation insecurity via parent questionnaires during WCVs.
- Examined acute healthcare usage (emergency department visits, hospitalizations) and WCV attendance rates.
Main Results:
- 8.7% of infants experienced transportation insecurity.
- Transportation insecurity was associated with lower WCV attendance, higher ED visits, and hospitalizations.
- WCV attendance did not mediate the link between transportation insecurity and acute healthcare use.
Conclusions:
- While transportation insecurity is linked to reduced WCV attendance, it does not appear to mediate acute healthcare usage.
- The findings highlight the need to explore other mechanisms connecting transportation insecurity to adverse health outcomes in infants.
- Interventions addressing transportation barriers may be necessary to improve infant health equity.
Objective:
To evaluate the role of well-child visits (WCVs) in mediating associations between transportation insecurity and acute health care usage among infants.
Methods:
This was a retrospective cohort study of 4114 infants seen for newborn visits at 3 primary care centers between February 1, 2019 and March 31, 2021. Each infant was followed through 15 months of age. The outcome of interest was acute health care usage, defined by high-acuity emergency department (ED) visits or hospitalization. The exposure was transportation insecurity as reported by parents through standardized questionnaires administered during WCVs. We stratified analyses by WCV attendance (≥6 WCVs vs <6 WCVs in the first 15 months of life) to assess whether WCVs mediated associations between acute health care usage and transportation insecurity.
Results:
Of 4114 eligible infants, 8.7% endorsed transportation insecurity. Patients reporting transportation insecurity, compared to those who did not, had higher rates of incomplete WCV attendance (60.3% vs 44.2%, P < 0.001), ED visitation (38.0% vs 28.7%; P < 0.001), and hospitalization (19.8% vs 14.1%; P = 0.004). Transportation insecurity, compared to no transportation security, was significantly associated with having <6 WCVs (adjusted odds ratio [aOR] 1.64, 95% confidence interval [CI] 1.29, 2.09), ED visitation (aOR 1.45, 95% CI 1.14, 1.85), and hospitalization (aOR 1.52, 95% CI 1.13, 2.04). However, WCV attendance did not mediate associations between transportation insecurity and ED visits or hospitalizations.
Conclusions:
Transportation insecurity was associated with fewer WCVs; however, WCV attendance did not mediate associations between acute health care usage and transportation insecurity. Future research could focus on mechanisms linking transportation insecurity to suboptimal health outcomes.
Related Concept Videos
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
01:20Attachment
01:30Preventive Healthcare Services
01:30Primary Healthcare Services
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...