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Assessing Inequities in Hospital Outcomes for Australian Children From Underserved Populations
Karen Zwi1,2, Jahidur Rahman Khan2, Seaneen Wallace1,2
1Department of Community Child Health, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.
Insights
Children and young people from underserved backgrounds face significant health inequities, with higher risks for hospitalizations and readmissions. Targeted interventions are crucial to address these disparities and improve health outcomes for all CYP.
Area of Science:
- Health Services Research
- Pediatric Health Outcomes
- Health Equity Studies
Background:
- Persistent health outcome inequities exist for children and young people (CYP) from various underserved populations.
- Quantifying these baseline inequities is essential for evaluating the effectiveness of future equity interventions.
Purpose of the Study:
- To quantify baseline health outcome inequities for underserved CYP.
- To establish a benchmark for measuring the impact of interventions aimed at reducing health disparities.
Main Methods:
- Analysis of electronic medical records for CYP from the Sydney Children's Hospitals Network (2015-2019).
- Primary outcomes included high-acuity presentations, potentially preventable hospitalizations (PPH), chronic condition hospitalizations, discharge against medical advice (DAMA), ward and critical care admission, readmission, and extended length of stay (LOS).
- Generalized estimating equation models were used to assess the relationship between underserved population status and health outcomes.
Main Results:
- Underserved CYP constituted one-third of inpatient and emergency department encounters.
- Increased risk observed for PPH (RR, 1.25), chronic conditions (RR, 1.09), DAMA (RR, 1.33), ward admission (RR, 1.16), readmission (RR, 1.48), extended inpatient LOS (RR, 1.21), and ED LOS (RR, 1.11) compared to nonunderserved populations.
- Indigenous CYP with a disability showed a 239% higher risk of readmission (RR, 3.39) compared to CYP without these risk factors.
Conclusions:
- Significant health inequities persist for underserved CYP, necessitating targeted interventions.
- Strategies proposed include enhanced patient identification, improved service access, and system-wide cultural change.
- Implementation within an equity learning health system framework is recommended to drive improvements.
Objectives:
Inequity in health outcomes for children and young people (CYP) from underserved populations (Indigenous, culturally and linguistically diverse, refugee and/or asylum seeking, out-of-home care backgrounds, and National Disability Insurance Scheme participants) persists. We quantify baseline inequities in health outcomes to measure the effectiveness of equity interventions.
Methods:
We analyzed electronic medical records on CYP from the Sydney Children's Hospitals Network between 2015 and 2019. The primary outcome measures were high-acuity presentations, potentially preventable hospitalizations (PPH), chronic condition hospitalizations, discharge against medical advice (DAMA), ward and critical care admission, readmission, and extended length of stay (LOS). We used generalized estimating equation models to examine the relationship between underserved population status and outcomes.
Results:
One third of 253 934 inpatient and 446 924 emergency department (ED) encounters were underserved CYP. Compared with nonunderserved populations, there was increased risk of PPH (relative risk [RR], 1.25; 95% CI, 1.23-1.27), chronic conditions (RR, 1.09; 95% CI, 1.07-1.10), DAMA (RR, 1.33; 95% CI, 1.19-1.49), ward admission (RR, 1.16; 95% CI, 1.15-1.18), readmission (RR, 1.48; 95% CI, 1.42-1.53), extended inpatient LOS (RR, 1.21; 95% CI, 1.18-1.24), and ED LOS (RR, 1.11; 95% CI, 1.10-1.12). As an example of cumulative risk, Indigenous CYP living with a disability had a 239% higher risk of readmission than CYP without these risk factors (RR, 3.39; 95% CI, 2.92-3.93).
Conclusions:
Interventions are required to reduce health inequities for underserved CYP. We present strategies that include improved patient identification, enhanced service access, and system-wide culture change within an equity learning health system.
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