Clinical outcomes in cystic fibrosis at 6 years of age with tricare insurance coverage

Collaco, Joseph M.; Vanscoy, Lori L.; Psoter, Kevin J.; Riekert, Kristin A.; Dickinson, Kimberly M.

doi:10.1016/j.jcf.2022.02.004

Cited by 3 publications

(5 citation statements)

References 5 publications

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“…The local electronic medical record at each site was queried to obtain the patient address (at the time of admission if possible), as well as primary payor and primary language spoken for each admission. Each of these indices, as well as race and ethnicity, have been shown to be relevant to health delivery and outcomes in acutely ill children and were thus considered important to evaluate for a possible association with PICU outcomes (3, 10, 12, 24–35). Addresses were mapped to census tract and subsequently assigned nationally normed overall COI categories of very low, low, moderate, high, or very high as well as a continuous ordinal variable (0–100) of neighborhood opportunity using the COI 2.0 (16).…”

Section: Methodsmentioning

confidence: 99%

“…Medicaid or Medicare managed care plans were classified as government insurance. Tricare was designated in the other rather than government category due to previous data indicating substantial differences in health exposures and outcomes of children with Tricare as compared with Medicaid or Medicare coverage (27). Deidentified data from each institution were compiled by the coordinating center.…”

Section: Methodsmentioning

confidence: 99%

“…admission if possible), as well as primary payor and primary language spoken for each admission. Each of these indices, as well as race and ethnicity, have been shown to be relevant to health delivery and outcomes in acutely ill children and were thus considered important to evaluate for a possible association with PICU outcomes (3,10,12,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) Exploratory analyses were performed evaluating 1) using PRISM III for severity of illness adjustment, 2) the COI subdomains (education, health and environment, social and economic), and 3) the period from March to December 2020 during which epidemiology of PICU admissions was different (28). Post hoc pairwise analyses were also performed between all COI categories when a statistically significant difference was identified for severity of illness and other clinical characteristics, with Bonferroni correction for multiple comparisons.…”

Section: Research In Contextmentioning

confidence: 99%

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Child Opportunity Index and Pediatric Intensive Care Outcomes: A Multicenter Retrospective Study in the United States*

McCrory,

Akande,

Slain

et al. 2023

Pediatric Critical Care Medicine

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Objectives: To evaluate for associations between a child’s neighborhood, as categorized by Child Opportunity Index (COI 2.0), and 1) PICU mortality, 2) severity of illness at PICU admission, and 3) PICU length of stay (LOS). Design: Retrospective cohort study. Setting: Fifteen PICUs in the United States. Patients: Children younger than 18 years admitted from 2019 to 2020, excluding those after cardiac procedures. Nationally-normed COI category (very low, low, moderate, high, very high) was determined for each admission by census tract, and clinical features were obtained from the Virtual Pediatric Systems LLC (Los Angeles, CA) data from each site. Interventions: None. Measurements and Main Results: Among 33,901 index PICU admissions during the time period, median patient age was 4.9 years and PICU mortality was 2.1%. There was a higher percentage of admissions from the very low COI category (27.3%) than other COI categories (17.2–19.5%, p < 0.0001). Patient admissions from the high and very high COI categories had a lower median Pediatric Index of Mortality 3 risk of mortality (0.70) than those from the very low, low, and moderate COI groups (0.71) (p < 0.001). PICU mortality was lowest in the very high (1.7%) and high (1.9%) COI groups and highest in the moderate group (2.5%), followed by very low (2.3%) and low (2.2%) (p = 0.001 across categories). Median PICU LOS was between 1.37 and 1.50 days in all COI categories. Multivariable regression revealed adjusted odds of PICU mortality of 1.30 (95% CI, 0.94–1.79; p = 0.11) for children from a very low versus very high COI neighborhood, with an odds ratio [OR] of 0.996 (95% CI, 0.993–1.00; p = 0.05) for mortality for COI as an ordinal value from 0 to 100. Children without insurance coverage had an OR for mortality of 3.58 (95% CI, 2.46–5.20; p < 0.0001) as compared with those with commercial insurance. Conclusions: Children admitted to a cohort of U.S. PICUs were often from very low COI neighborhoods. Children from very high COI neighborhoods had the lowest risk of mortality and observed mortality; however, odds of mortality were not statistically different by COI category in a multivariable model. Children without insurance coverage had significantly higher odds of PICU mortality regardless of neighborhood.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Research In Contextmentioning

confidence: 99%

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Child Opportunity Index and Pediatric Intensive Care Outcomes: A Multicenter Retrospective Study in the United States*

McCrory,

Akande,

Slain

et al. 2023

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

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“…Employer‐based insurance was defined as having any private health insurance or Tricare (healthcare coverage for members of the US military and their dependents). Although Tricare coverage is funded through the US federal government, it was treated as employer‐based coverage based on a recent study of young children with cystic fibrosis with Tricare coverage having respiratory outcomes more akin to those with private insurance as opposed to other forms of public insurance coverage, including Medicaid 24 . Subjects were classified into one of two groups based on all available data: (1) always having employer‐based insurance or (2) any period of time having public insurance (Medicaid) as sole coverage.…”

Section: Methodsmentioning

confidence: 99%

“…Although Tricare coverage is funded through the US federal government, it was treated as employer-based coverage based on a recent study of young children with cystic fibrosis with Tricare coverage having respiratory outcomes more akin to those with private insurance as opposed to other forms of public insurance coverage, including Medicaid. 24 Subjects were classified into one of two groups based on all available data: (1) always having employer-based insurance or (2) any period of time having public insurance (Medicaid) as sole coverage. Individuals with employer-based insurance and back-up public insurance were included in the employer-based group.…”

Section: Data Collectionmentioning

confidence: 99%