Lost Earnings and Nonmedical Expenses of Pediatric Hospitalizations

Chang, Lenisa V.; Shah, Anita N.; Hoefgen, Erik R.; Auger, Katherine A.; Weng, Huibin; Simmons, Jeffrey M.; Shah, Samir S.; Beck, Andrew F.

doi:10.1542/peds.2018-0195

Cited by 59 publications

(31 citation statements)

References 34 publications

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“…The medical and nonmedical financial costs of a hospital admission may be especially catastrophic for the already financially distressed family 27,28 and may be worsened by the comparatively higher costs of a PICU admission. Lower-income earners commonly have jobs that tend to have less work flexibility, 28,29 causing these parents the added distress of having to choose between dedicating time to earning income or being with their critically ill child. The inequitable acute and longer-term burdens of critical illness on lowincome children, families, and communities merit focused investigation and action.…”

Section: Discussionmentioning

confidence: 99%

Neighborhood Poverty and Pediatric Intensive Care Use

et al. 2019

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BACKGROUND: Disparities in health service use have been described across a range of sociodemographic factors. Patterns of PICU use have not been thoroughly assessed. METHODS: This was a population-level, retrospective analysis of admissions to the Cincinnati Children's Hospital Medical Center PICU between 2011 and 2016. Residential addresses of patients were geocoded and spatially joined to census tracts. Pediatric patients were eligible for inclusion if they resided within Hamilton County, Ohio. PICU admission and bed-day rates were calculated by using numerators of admissions and bed days, respectively, over a denominator of tract child population. Relationships between tract-level PICU use and child poverty were assessed by using Spearman's r and analysis of variance. Analyses were event based; children admitted multiple times were counted as discrete admissions. RESULTS: There were 4071 included admissions involving 3129 unique children contributing a total of 12 297 PICU bed days. Child poverty was positively associated with PICU admission rates (r = 0.59; P , .001) and bed-day rates (r = 0.47; P , .001). When tracts were grouped into quintiles based on child poverty rates, the PICU bed-day rate ranged from 23.4 days per 1000 children in the lowest poverty quintile to 81.9 days in the highest poverty quintile (P , .001). CONCLUSIONS: The association between poverty and poor health outcomes includes pediatric intensive care use. This association exists for children who grow up in poverty and around poverty. Future efforts should characterize the interplay between patient-and neighborhoodlevel risk factors and explore neighborhood-level interventions to improve child health. WHAT'S KNOWN ON THIS SUBJECT: Poverty adversely affects health. The health impacts of socioeconomic status and poverty occur at the individual and community levels. Socioeconomic disparities in PICU use have not been as robustly assessed compared with other medical disciplines. WHAT THIS STUDY ADDS: Socioeconomic disparities extend to pediatric critical illness. Neighborhood poverty affects children' s need for intensive care. We argue that this association represents more than an aggregate of individual risk factors, and the interplay of individual and community demographics merits further investigation.

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Section: Discussionmentioning

confidence: 99%

Neighborhood Poverty and Pediatric Intensive Care Use

et al. 2019

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“…For febrile infants aged ≤60 days with bacteremia or meningitis, 88%-89% of the pathogens present are detected by 24 hours, and 95% are detected by 36 hours; well-appearing infants could be considered for discharge after 24 hours. 6. A newly developed, validated rounding tool focusing on high-value care items can be incorporated into family-centered rounds.…”

Section: Nonmedical Costs Of Hospitalizations Can Cause Significant Fmentioning

confidence: 99%

Updates in Pediatric Hospital Medicine: Six Practical Ways to Improve the Care of Hospitalized Children

Edgar-Zarate

Russo

2019

J Hosp Med

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T he field of pediatric hospital medicine has seen tremendous growth in scholarship in the past decade. To obtain a wide view of advancements in the field from the current literature, the authors selected 18 English-language journals (Table 1) across four domains believed to be relevant to the practice of pediatric hospital medicine, including hospital medicine, pediatrics, emergency care, and medical education. The median Hirsch index (h-index) of the selected journals was 131. A goal of 10, a number that could maximally benefit consumers of the finished product, was set as the final number of articles to be selected.Guiding principles for the initial selection included novelty of hypotheses, study design, significance of results, and likelihood to change pediatric hospital medicine practice from both the community and academic hospital perspectives. Journals were assigned randomly to each author for review and assignments were switched after six months to limit potential bias in coverage. A three-stage review process was employed. The authors initially independently reviewed titles and abstracts from 13,296 articles published between January 2018 and December 2018 and rated them according to their likelihood to be included in the final set of 10 articles and their broad applicability to pediatric hospital medicine. This resulted in 99 studies that were selected for further review. Next, the authors were assigned a subset of the 99 articles for further review;

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“…[18][19][20] Medically complex children also represent an increasing percentage of patients admitted to children's hospitals 21,22 where their families may be more vulnerable to worsening financial difficulties caused by direct costs and income depletion-due to lost wages, transportation, and meals-associated with hospitalization. 23 The hospitalized population can be readily screened and provided interventions. Although evidence on effective inpatient financial interventions is lacking, financial navigation pro-BACKGROUND: High costs of hospitalization may contribute to financial difficulties for some families.…”

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confidence: 99%

Financial Difficulties in Families of Hospitalized Children

Bassett

Coller

Beck

et al. 2020

Journal of Hospital Medicine

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BACKGROUND: High costs of hospitalization may contribute to financial difficulties for some families. OBJECTIVE: To examine the prevalence of financial distress and medical financial burden in families of hospitalized children and identify factors that can predict financial difficulties. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional survey of parents of hospitalized children at six children’s hospitals between October 2017 and November 2018. MAIN OUTCOMES AND MEASURES: The outcomes were high financial distress and medical financial burden. Multivariable logistic regression identified predictors of each outcome. The primary predictor variable was level of chronic disease (complex chronic disease, C-CD; noncomplex chronic disease, NC-CD; no chronic disease, no-CD). RESULTS: Of 644 invited participants, 526 (82%) were enrolled, with 125 (24%) experiencing high financial distress, and 160 (30%) reporting medical financial burden. Of those, 86 (54%) indicated their medical financial burden was caused by costs associated with their hospitalized child. Neither C-CD nor NC-CD were associated with high financial distress. Child-related medical financial burden was associated with both C-CD and NC-CD (adjusted odds ratio [AOR], 4.98; 95% CI, 2.41-10.29; and AOR, 2.57; 95% CI, 1.11-5.93), compared to no-CD. Although household poverty level was associated with both measures, financial difficulties occurred in all family income brackets. CONCLUSION: Financial difficulties are common in families of hospitalized children. Low-income families and those who have children with chronic conditions are at particular risk; however, financial difficulties affect all subsets of the pediatric population. Hospitalization may be a prime opportunity to identify and engage families at risk for financial distress and medical financial burden.

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Lost Earnings and Nonmedical Expenses of Pediatric Hospitalizations

Abstract: Nonmedical costs place burdens on families of children who are hospitalized, disproportionately affecting those with competing socioeconomic challenges.

Cited by 59 publications

References 34 publications

Neighborhood Poverty and Pediatric Intensive Care Use

Neighborhood Poverty and Pediatric Intensive Care Use

Updates in Pediatric Hospital Medicine: Six Practical Ways to Improve the Care of Hospitalized Children

Financial Difficulties in Families of Hospitalized Children

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