Child Opportunity Index 2.0 and acute care utilization among children with medical complexity

Fritz, Cristin Q.; Hall, Matthew; Bettenhausen, Jessica L.; Beck, Andrew F.; Krager, Molly; Freundlich, Katherine L.; Ibrahim, Dena; Thomson, Joanna; Gay, James C.; Carroll, Alison R.; Neeley, Maya; Frost, Patricia; Herndon, Alison; Kehring, Allysa L.; Williams, Derek J.

doi:10.1002/jhm.12810

Cited by 27 publications

(17 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This relationship persisted in children with the highest injury severity—those categorized as Complicated TBI. Our results complement previous studies showing an association between low COI ZIP codes and higher hospital utilization in children with medical complexity and children with ambulatory care-sensitive conditions ( 33 , 34 ). Our study methodology precludes understanding reasons for these findings but may be reflective of inefficient discharge processes or insufficient availability of post-hospital rehabilitation services contributing to unnecessary hospitals days in families living in communities with low opportunity ( 35 , 36 ).…”

Section: Discussionsupporting

confidence: 91%

“…In our study, costs were over $3,000 higher per hospitalization in very low COI patients compared with very high COI patients; over the 4-year study period, children living in very low COI ZIP codes accrued over $8.8 million more in hospital costs. Similar findings of higher expenditures are reported among hospitalized children with medical complexity living in very low COI ZIP codes and in low-income children hospitalized with asthma, bronchiolitis, pneumonia, diabetes, and congenital heart disease ( 7 , 20 , 26 , 34 ). Since U.S. children’s hospitals tend to serve patients with the greatest medical complexity and social vulnerability, they are disproportionately burdened by the financial losses associated with Medicaid reimbursements ( 38 ).…”

Section: Discussionsupporting

confidence: 78%

See 1 more Smart Citation

Child Opportunity Index and Hospital Utilization in Children With Traumatic Brain Injury Admitted to the PICU

Gray

Malay

Kleinman

et al. 2023

Critical Care Explorations

View full text Add to dashboard Cite

IMPORTANCE: The need to understand how Community-based disparities impact morbidity and mortality in pediatric critical illness, such as traumatic brain injury. Test the hypothesis that ZIP code-based disparities in hospital utilization, including length of stay (LOS) and hospital costs, exist in a cohort of children with traumatic brain injury (TBI) admitted to a PICU using the Child Opportunity Index (COI). DESIGN: Multicenter retrospective cohort study. SETTING: Pediatric Health Information System (PHIS) database. PATIENTS: Children 0–18 years old admitted to a PHIS hospital with a diagnosis of TBI from January 2016 to December 2020 requiring PICU care. To identify the most severely injured children, a study-specific definition of “Complicated TBI” was created based on radiology, pharmacy, and procedure codes. INTERVENTIONS: None. Main Outcomes and Measures: Using nationally normed ZIP code-level COI data, patients were categorized into COI quintiles. A low COI ZIP code has low childhood opportunity based on weighted indicators within educational, health and environmental, and social and economic domains. Population-averaged generalized estimating equation (GEE) models, adjusted for patient and clinical characteristics examined the association between COI and study outcomes, including hospital LOS and accrued hospital costs. The median age of this cohort of 8,055 children was 58 months (interquartile range [IQR], 8–145 mo). There were differences in patient demographics and rates of Complicated TBI between COI levels. The median hospital LOS was 3.0 days (IQR, 2.0–6.0 d) and in population-averaged GEE models, children living in very low COI ZIP codes were expected to have a hospital LOS 10.2% (95% CI, 4.1–16.8%; p = 0.0142) longer than children living in very high COI ZIP codes. For the 11% of children with a Complicated TBI, the relationship between COI and LOS was lost in multivariable models. COI level was not predictive of accrued hospital costs in this study. CONCLUSIONS: Children with TBI requiring PICU care living in low-opportunity ZIP codes have higher injury severity and longer hospital LOS compared with children living in higher-opportunity ZIP codes. Additional studies are needed to understand why these differences exist.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 78%

Child Opportunity Index and Hospital Utilization in Children With Traumatic Brain Injury Admitted to the PICU

Gray

Malay

Kleinman

et al. 2023

Critical Care Explorations

View full text Add to dashboard Cite

show abstract

“…Larger studies of hospital utilization illustrate crude associations with demographics, including race/ethnicity or public insurance 37 . CMC living in communities with greater resources, such as access to health care, clean air, quality schools and safe housing spend less time in the emergency department and fewer days hospitalized 38 . The influence of more specific social determinants of health and hospitalizations for CMC comes primarily from smaller studies, often among CMC in complex care programs, making associations harder to interpret 39,40 .…”

Section: Needed Social and Policy Focusmentioning

confidence: 99%

Admitting what is needed: How the health system and society can reduce hospitalizations for children with medical complexity

Chen

Gerber

Coller

2022

Journal of Hospital Medicine

View full text Add to dashboard Cite

Hospitalization is a relatively common occurrence for patients with medical complexity. In fact, high health care use is a defining feature of children with medical complexity (CMC). 1 CMC are a heterogeneous and growing population, unified by conceptual similarities: multisystem and frequently progressive chronic conditions leading to substantial functional limitations, familyidentified service needs, and high healthcare use. 1 Annually, approximately 13%-20% of CMC are hospitalized 2,3 and 50%-80% of CMC healthcare spending goes to hospital care. 1,3,4 However, some hospitalizations experienced by CMC are avoidable. 5 Substantial variation in hospital utilization for CMC across

show abstract

“…In absolute utilization days, children from the lowest COI quintiles used over a week more days on average than children in the highest quintile (47.1 vs. 38.6 days). 3 The findings provide a timely reminder of the importance and contribution of social determinants of health (SDOH) to the experience of patients, their families, and healthcare systems, including payers, representing time away from family, home, work, and school, and increased cost for all involved.…”

mentioning

confidence: 99%

“…CMC also have higher rates of social complexity; their families are more likely to report unmet needs as well as financial and social hardships 2 . In this issue of JHM , Fritz et al 3 explore the interplay of neighborhood social factors and acute care utilization among CMC.…”

mentioning

confidence: 99%

Beyond the hospital walls—Addressing social complexity in children with medical complexity

Diskin

Cohen

2022

Journal of Hospital Medicine

View full text Add to dashboard Cite

show abstract

Child Opportunity Index 2.0 and acute care utilization among children with medical complexity

Cited by 27 publications

References 33 publications

Child Opportunity Index and Hospital Utilization in Children With Traumatic Brain Injury Admitted to the PICU

Child Opportunity Index and Hospital Utilization in Children With Traumatic Brain Injury Admitted to the PICU

Admitting what is needed: How the health system and society can reduce hospitalizations for children with medical complexity

Beyond the hospital walls—Addressing social complexity in children with medical complexity

Contact Info

Product

Resources

About