Related Experiment Videos
Child Opportunity Index and 30-Day Readmission Among Children Discharged With New Long-Term Mechanical Ventilation
Lindsey L Scheller1,2, Abbey Alkon2, Thomas J Hoffmann3
1National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA.
Insights
Neighborhood opportunity did not impact 30-day readmission for children on long-term mechanical ventilation via tracheostomy (LTMV-T). About 26% of these pediatric patients were readmitted, highlighting a need for interventions to reduce hospital returns.
Area of Science:
- Pediatric Health Outcomes
- Social Determinants of Health Research
- Health Services Research
Background:
- Children discharged on long-term mechanical ventilation via tracheostomy (LTMV-T) face high readmission risks.
- Neighborhood socioeconomic factors, measured by the Child Opportunity Index (COI), may influence health outcomes.
- Understanding these associations is crucial for targeted interventions.
Purpose of the Study:
- To investigate the link between neighborhood-level social determinants of health (SDOH), using the COI, and 30-day all-cause same-hospital readmission in pediatric patients newly discharged on LTMV-T.
Main Methods:
- A multicenter, retrospective cohort study analyzed data from 47 pediatric hospitals in the Pediatric Health Information System (PHIS) database.
- The study included children aged 0-18 years newly discharged on LTMV-T between 2014 and 2023.
- Child Opportunity Index (COI) was used to assess neighborhood-level SDOH, with outcomes analyzed using multivariable mixed-effects models.
Main Results:
- Of 5927 children, 26% experienced 30-day readmission. Half resided in low-opportunity neighborhoods.
- No significant association was found between lower COI neighborhoods and increased 30-day readmission risk compared to very high COI neighborhoods.
- Older age at discharge and discharge to other facilities were associated with lower readmission odds, while longer length of stay increased readmission odds.
Conclusions:
- Approximately one in four pediatric patients discharged with new LTMV-T were readmitted within 30 days.
- Neighborhood opportunity levels, as measured by COI, were not associated with 30-day readmission rates in this cohort.
- Further research and interventions are needed to address the significant burden of early readmissions for this vulnerable pediatric population.
Objectives:
To examine the association between neighborhood-level social determinants of health (SDOH), as measured by the Child Opportunity Index (COI), and 30-day all-cause same-hospital readmission among children newly discharged on long-term mechanical ventilation via tracheostomy (LTMV-T).
Design:
Multicenter, retrospective cohort study.
Setting:
Forty-seven pediatric hospitals contributing data to the Pediatric Health Information System (PHIS) database.
Patients:
Children of 0-18 years old with newly used LTMV-T between 2014 and 2023.
Interventions:
None.
Measurements And Main Results:
The COI is a composite measure of neighborhood-level SDOH, reported in quintiles (very low to very high opportunity). The primary outcome was 30-day all-cause same-hospital readmission, defined as the first observation or inpatient unit readmission to the index hospital where tracheostomy and ventilator initiation had occurred. Other clinical characteristics and demographic data were collected. Of the 5927 children identified in the PHIS database, 26% of children ( n = 1521) were readmitted within 30 days. Half of the cohort lived in very low- to low-opportunity neighborhoods. Multivariable mixed-effects models did not identify an association between 30-day readmission and living in lower compared with very high COI neighborhoods. Factors associated with lower odds (adjusted odds ratio [aOR; 95% CI]) of readmission were older age at discharge (e.g., ≥ 11 yr vs. < 6 mo; aOR, 0.64 [95% CI, 0.49-0.84]) and discharge to other health care facilities (vs. home discharge aOR, 0.64 [95% CI, 0.54-0.76]). Regarding length of stay, there was a 3% greater odds of readmission for every additional 30 days (aOR, 1.03 [95% CI, 1.01-1.04]).
Conclusions:
The PHIS database (2014-2023) shows that around one-in-four admissions discharged with new LTMV-T were readmitted within 30 days. However, we failed to identify an association between residence in lower compared with very high COI neighborhoods and 30-day readmission. Given the early readmission burden, future efforts should prioritize interventions to reduce hospital returns.
Related Concept Videos
01:21Tracheostomy Decannulation
Description of the Procedure
Decannulation refers to the permanent removal of the tracheostomy tube, signaling the resolution of the condition that initially necessitated the tracheostomy. The process requires a well-coordinated interplay between...
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation (NIPPV)
01:23Oxygen Delivering System III: Tracheostomy and T-piece
Tracheostomy
A tracheostomy is a surgically created opening (stoma) in the anterior part of the trachea. It is used to establish a patient airway, bypass an upper airway obstruction, simplify the removal of secretions, permit long-term...
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
01:29Mechanical Ventilation I: Indication and Settings