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Potentially preventable hospitalisations for Aboriginal children with experience of out-of-home care: a data linkage
Benjamin Harrap1, Alison Gibberd2, Melissa O'Donnell3
1Melbourne School of Population and Global Health, Level 3, The University of Melbourne, Australia.
Insights
Aboriginal children in out-of-home care (OOHC) experienced 2.3 times more potentially preventable hospitalizations (PPH). While PPH reduced after initial OOHC placement, rates remained higher, indicating persistent healthcare disparities.
Area of Science:
- Indigenous child health
- Public health policy
- Healthcare access
Background:
- Potentially preventable hospitalizations (PPH) are indicators of primary healthcare system performance.
- Out-of-home care (OOHC) is a significant intervention for children requiring protection.
- Understanding PPH rates among Aboriginal children in OOHC is crucial for health equity.
Purpose of the Study:
- To compare PPH rates and conditions in Aboriginal children based on OOHC exposure.
- To assess the impact of the first OOHC placement on PPH rates.
Main Methods:
- Retrospective longitudinal study utilizing linked hospitalization and child protection data.
- Matched cohort of Aboriginal children born in Western Australia (2000-2013).
- Analysis of observed and predicted PPH rates.
Main Results:
- Children ever in OOHC had 2.3 times higher PPH bed day rates than those never placed.
- PPH bed days decreased by 11% post-first OOHC placement but did not reach parity.
- Dental and otitis media-related PPHs increased after the first OOHC placement.
Conclusions:
- Aboriginal children with OOHC experience exhibit persistently higher PPH bed day rates.
- Systemic factors including healthcare capacity, cultural safety, and family support require improvement.
- Addressing these factors is essential to reduce PPH rates and improve health outcomes.
Objective:
To compare potentially preventable hospitalisation (PPH) rates and types of conditions for Aboriginal children by exposure to out-of-home care (OOHC) and estimate the effect of first OOHC placement on PPH rates.
Methods:
A retrospective longitudinal study of linked hospitalisation and child protection data for a matched cohort of Aboriginal children born in Western Australia between 2000 and 2013 using observed and predicted rates.
Results:
Incidence rate of PPH bed days was 2.3 times higher for children ever-placed in OOHC than never-placed children. Diagnosed conditions showed no difference between ever and never-placed children across all ages. On average, PPH bed days reduced by 11% (95% confidence interval: 3% to 18%) following the first OOHC placement but never reached parity with never-placed children. For dental and otitis media-related PPHs, rates increased following first placement.
Conclusions:
Children with experience of OOHC had greater rates of PPH bed days which persisted despite reductions following first OOHC placement.
Implications For Public Health:
Healthcare system capacity, cultural safety, and access, as well as the material conditions of families at risk of CPS intervention, all need to be improved if rates of PPHs are to be reduced.
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