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Does Early Life Adversity Limit Delivery of High-Quality Health Care Among Children?
Héctor E Alcalá1,2, Zeruiah V Buchanan3,4, Jun Chu5
1Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park, Maryland, USA.
Insights
Adverse childhood experiences (ACEs) are linked to poorer health care quality. Children with more ACEs need more medical decisions but receive less shared decision-making from providers.
Area of Science:
- Pediatric Health Services Research
- Childhood Trauma and Health Outcomes
- Healthcare Quality Improvement
Background:
- Adverse childhood experiences (ACEs) are linked to negative health outcomes and reduced use of preventive services.
- The association between ACEs and the quality of healthcare received, specifically shared decision-making, is not well understood.
Purpose of the Study:
- To investigate the relationship between ACEs and the need for medical decisions.
- To examine how ACEs influence the extent to which children experience shared decision-making in healthcare.
Main Methods:
- Utilized data from the 2021-2022 National Survey of Children's Health (n=47,179).
- Employed logistic regression to assess the association between individual ACEs, cumulative ACEs, and outcomes related to medical decision-making and shared decision-making.
- Analyzed 11 individual ACEs and the cumulative number of ACEs as independent variables.
Main Results:
- Higher numbers of ACEs and most individual ACEs were associated with increased odds of needing medical decisions.
- Experiencing ACEs was linked to lower odds of always receiving care involving shared decision-making across three measures.
- These associations persisted after controlling for confounding factors.
Conclusions:
- ACEs are associated with diminished healthcare quality, specifically reduced shared decision-making.
- This finding is critical as children with ACEs often have greater healthcare needs and are less likely to utilize services.
- Improving healthcare quality, including shared decision-making, can disproportionately benefit vulnerable children with a history of ACEs.
Background:
Adverse childhood experiences (ACEs) have been associated with poor health and underuse of preventive health services. However, less is known about how ACEs are associated with quality of care that children receive, like care that involves shared decision-making.
Methods:
Using data from the 2021-2022 National Survey of Children's Health (n = 47 179) the association between ACEs, both individual and cumulative and (1) needing medical decisions made in the past 12 months and (2) three different measures of always receiving care that involved shared decision-making. Logistic regression models were used to calculate odds of each outcome. Each of the 11 ACEs and the cumulative number of ACEs served as independent variables each in separate models.
Results:
After accounting for confounders, the number of ACEs experienced, and most individual ACE items were associated with higher odds of needing medical decisions made, and lower odds of receiving health care that involved providers always engaging in the three measures of shared decision-making.
Conclusions:
This study expands the research showing a deleterious impact of ACEs on utilization of health care by showing that ACEs are associated with lower quality health care. This can be particularly determinantal to children with a history of ACEs because they have a greater need for health care and are less likely to use many types of health care. Efforts to improve health care quality for all children will be of particular benefit to vulnerable groups, like those with a history of ACEs.
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