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Social disparities in the use of diagnostic tests for children with gastroenteritis
J M Quintana1, D Goldmann, C Homer
1Department of Quality Improvement and Hospital Epidemiology, Children's Hospital, Boston, MA 02115, USA.
Insights
Patient race and insurance status influenced diagnostic test use in children with acute gastroenteritis. Hispanic and self-pay children received fewer tests, highlighting potential disparities in pediatric emergency care.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Health Equity
Background:
- Acute gastroenteritis is a common pediatric condition managed in emergency departments.
- Diagnostic test utilization can vary among patient populations.
- Understanding demographic influences on testing is crucial for equitable care.
Purpose of the Study:
- To investigate the association between patient demographic characteristics and the use of diagnostic tests for pediatric acute gastroenteritis.
- To identify potential disparities in diagnostic testing based on race and insurance status.
Main Methods:
- Retrospective chart review of 503 children diagnosed with acute gastroenteritis in a tertiary care pediatric hospital.
- Analysis of sociodemographic factors (race, insurance) and diagnostic test orders.
- Multivariate logistic regression using generalized estimating equations (GEE) to adjust for confounding variables.
Main Results:
- Hispanic children were less likely to undergo extensive diagnostic testing (more than two tests) or have an X-ray ordered.
- Self-pay patients were also less likely to have diagnostic tests performed.
- These associations persisted after adjusting for age and illness characteristics.
Conclusions:
- Patient social characteristics, including race and insurance status, are associated with differential patterns of diagnostic test use in pediatric acute gastroenteritis.
- Healthcare providers should aim to minimize care variations based on social and economic factors unrelated to medical need.
- Further research is needed to assess the impact of these disparities on patient outcomes.
Objective:
To determine whether patient demographic characteristics affect the use of diagnostic tests for the evaluation of children with acute gastroenteritis by emergency department (ED) physicians.
Design:
Retrospective chart review.
Setting:
Emergency department of a tertiary care pediatric hospital.
Sample:
All patients seen in the emergency department over a six-month period with a discharge diagnosis of acute gastroenteritis (GE) as identified through a computerized patient log (n = 503).
Measures And Analysis:
Sociodemographic characteristics ("race" and insurance) were obtained from computerized hospital data. The number of tests ordered was identified from the medical records, as were indicators of illness severity. We utilized multivariate logistic regression using the generalized estimating equations (GEE) model to account for repeated visits and adjust for potential confounding.
Results:
Hispanic children were less likely to undergo more than two tests [OR.53 (95% CI.31,.92)] or have an X-ray done [OR.31 (95% CI 0.15, 0.67)], after adjustment for age and disease characteristics. Self-pay patients were less likely to have a test performed [OR.53 (95% CI.3,.96)].
Conclusions:
Some patient social characteristics remain associated with differing patterns of use of diagnostic tests for a common pediatric condition. Although this study provides no information on patient outcome, health providers should strive to reduce differences in care based on patient social and economic factors as distinct from characteristics of the patient's condition or medical need.
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