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Association between Child Opportunity Index and paediatric sepsis recognition and treatment in a large quality
Lori Rutman1,2, Troy Richardson3, Jeffery Auletta4
1Pediatric Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA lori.rutman@seattlechildrens.org.
Insights
Child Opportunity Index (COI) disparities in pediatric sepsis care improved over time, with the greatest gains in recognition and care for children in the lowest COI quintile. Quality improvement collaboratives can reduce these disparities.
Area of Science:
- Pediatric healthcare quality
- Health services research
- Sepsis management
Background:
- The Child Opportunity Index (COI) measures neighborhood conditions vital for child development and is linked to healthcare delivery and outcomes.
- Formal quality improvement (QI) initiatives may impact the relationship between COI, care quality, and pediatric outcomes.
Purpose of the Study:
- To examine the association between COI and pediatric sepsis care delivery and outcomes.
- To determine if baseline disparities in care changed over time within the Improving Pediatric Sepsis Outcomes (IPSO) collaborative.
Main Methods:
- Retrospective cohort study of pediatric sepsis patients (2017-2021) linked to the Pediatric Health Information System database.
- Primary exposure: Child Opportunity Index (COI) quintiles.
- Assessed identification via standardized sepsis recognition protocols and adherence to a recommended care bundle, including timeliness and mortality.
Main Results:
- 31,260 sepsis cases from 24 hospitals were analyzed.
- Patients in the Very High COI quintile had the highest rates of standardized recognition (67.7%) and care bundle receipt (46%).
- Standardized sepsis recognition improved across all COI quintiles over time, with the most significant improvements observed in the Very Low COI quintile.
Conclusions:
- Significant disparities in pediatric sepsis care delivery exist based on COI.
- The IPSO collaborative demonstrated that care improved most for children in the lowest COI quintile.
- QI collaboratives utilizing standardization and shared learning show potential for reducing healthcare disparities.
Background:
The Child Opportunity Index (COI) is a multidimensional measure of US neighbourhood-level conditions needed for healthy development. COI is associated with healthcare delivery and outcomes. Formal quality improvement (QI) may influence the relationship between COI, quality of care and outcomes in children.
Objective:
To assess the association between COI and paediatric sepsis care delivery and outcomes and determine if baseline disparities in care change over time among hospitals in the Improving Pediatric Sepsis Outcomes (IPSO) collaborative.
Methods:
Retrospective cohort study of IPSO patients probabilistically linked to the Pediatric Health Information System database from 2017 to 2021. Primary exposure was COI. We estimated differences in the proportions of patients in each COI quintile identified via standardised sepsis recognition protocols (screening tool, huddle documentation and/or order set use) and who received a bundle of recommended care (standardised sepsis recognition, plus bolus <1 hour and antibiotic <3 hours). We further assessed the timeliness of each bundle component and mortality. We evaluated changes in standardised sepsis recognition over time using generalised linear models.
Results:
31 260 sepsis cases from 24 hospitals were included. Cross-sectional analysis over the entire study period found patients in the Very High COI quintile were most likely to be identified via standardised recognition protocols and receive IPSO's recommended care bundle (67.7% and 46%, respectively). Over time, standardised sepsis recognition improved for all; the greatest improvements were among inpatients in the Very Low COI quintile.
Conclusion:
Disparities exist in paediatric sepsis care delivery by COI. Over the course of the IPSO collaborative, care improved most for children in the lowest COI quintile. QI collaboratives focused on standardisation and shared learning may reduce disparities.
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