Racial Differences in the Utilization of Guideline-Recommended and Life-Sustaining Procedures During Hospitalizations for Out-of-Hospital Cardiac Arrest

Woo, Kenneth K; Can, Argun; Chang, Dong

doi:10.1007/s40615-019-00668-8

Cited by 5 publications

(8 citation statements)

References 34 publications

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“…Studies show high risk Black infants are less likely to be referred to neonatal follow up clinics, and Black mothers report experiencing indifferent and ineffective communication from medical staff, impacting effective familycentered care (26)(27)(28)(29). There is also adult literature to suggest that Black families are more likely to choose life-sustaining medical technology for their kin following cardiac arrest, trauma, and stroke, but suffer from more adverse events, worse patient experiences, and less improvement in functional outcomes when receiving home health care (30)(31)(32)(33)(34)(35). Our study design precludes understanding why technology-dependent Black children have higher hospital and PICU utilization.…”

Section: Discussionmentioning

confidence: 99%

Social Factors Predictive of Intensive Care Utilization in Technology-Dependent Children, a Retrospective Multicenter Cohort Study

et al. 2021

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Objective: Technology-dependent children with medical complexity (CMC) are frequently admitted to the pediatric intensive care unit (PICU). The social risk factors for high PICU utilization in these children are not well described. The objective of this study was to describe the relationship between race, ethnicity, insurance status, estimated household income, and PICU admission following the placement of a tracheostomy and/or gastrostomy (GT) in CMC.Study Design: This was a retrospective multicenter study of children <19 years requiring tracheostomy and/or GT placement discharged from a hospital contributing to the Pediatric Health Information System (PHIS) database between January 2016 and March 2019. Primary predictors included estimated household income, insurance status, and race/ethnicity. Additional predictor variables collected included patient age, sex, number of chronic complex conditions (CCC), history of prematurity, and discharge disposition following index hospitalization. The primary outcome was need for PICU readmission within 30 days of hospital discharge. Secondary outcomes included repeated PICU admissions and total hospital costs within 1 year of tracheostomy and/or GT placement.Results: Patients requiring a PICU readmission within 30 days of index hospitalization for tracheostomy or GT placement accounted for 6% of the 20,085 included subjects. In multivariate analyses, public insurance [OR 1.28 (95% C.I. 1.12–1.47), p < 0.001] was associated with PICU readmission within 30 days of hospital discharge while living below the federal poverty threshold (FPT) was associated with a lower odds of 30-day PICU readmission [OR 0.7 (95% C.I. 0.51–0.95), p = 0.0267]. Over 20% (n = 4,197) of children required multiple (>1) PICU admissions within one year from index hospitalization. In multivariate analysis, Black children [OR 1.20 (95% C.I. 1.10–1.32), p < 0.001] and those with public insurance [OR 1.34 (95% C.I. 1.24–1.46), p < 0.001] had higher odds of multiple PICU admissions. Social risk factors were not associated with total hospital costs accrued within 1 year of tracheostomy and/or GT placement.Conclusions: In a multicenter cohort study, Black children and those with public insurance had higher PICU utilization following tracheostomy and/or GT placement. Future research should target improving healthcare outcomes in these high-risk populations.

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Section: Discussionmentioning

confidence: 99%

Social Factors Predictive of Intensive Care Utilization in Technology-Dependent Children, a Retrospective Multicenter Cohort Study

et al. 2021

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“…47 Conversely, Woo et al found that Black and Hispanic patients received significantly lower rates of palliative care consultation and higher rates of aggressive care including renal replacement therapy, percutaneous gastrostomy, and tracheostomy. 48 However, this was a cohort of patients presenting with OOHCA, suggesting that trends may be divergent depending on the setting in which a patient arrests. 48 …”

Section: Discussionmentioning

confidence: 96%

“… 48 However, this was a cohort of patients presenting with OOHCA, suggesting that trends may be divergent depending on the setting in which a patient arrests. 48 …”

Section: Discussionmentioning

confidence: 96%

Racial and Ethnic Disparities in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction

Subramaniam

Patlolla

Cheungpasitporn

et al. 2021

JAHA

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Background The role of race and ethnicity in the outcomes of cardiac arrest (CA) complicating acute myocardial infarction (AMI) is incompletely understood. Methods and Results This was a retrospective cohort study of adult admissions with AMI‐CA from the National Inpatient Sample (2012–2017). Self‐reported race/ethnicity was classified as White, Black, and others (Hispanic, Asian or Pacific Islander, Native American, Other). Outcomes of interest included in‐hospital mortality, coronary angiography, percutaneous coronary intervention, palliative care consultation, do‐not‐resuscitate status use, hospitalization costs, hospital length of stay, and discharge disposition. Of the 3.5 million admissions with AMI, CA was noted in 182 750 (5.2%), with White, Black, and other races/ethnicities constituting 74.8%, 10.7%, and 14.5%, respectively. Black patients admitted with AMI‐CA were more likely to be female, with more comorbidities, higher rates of non–ST‐segment–elevation myocardial infarction, and higher neurological and renal failure. Admissions of patients of Black and other races/ethnicities underwent coronary angiography (61.9% versus 70.2% versus 73.1%) and percutaneous coronary intervention (44.6% versus 53.0% versus 58.1%) less frequently compared to patients of white race ( p <0.001). Admissions of patients with AMI‐CA had significantly higher unadjusted mortality (47.4% and 47.4%) as compared with White patients admitted (40.9%). In adjusted analyses, Black race was associated with lower in‐hospital mortality (odds ratio [OR], 0.95; 95% CI, 0.91–0.99; P =0.007) whereas other races had higher in‐hospital mortality (OR, 1.11; 95% CI, 1.08–1.15; P <0.001) compared with White race. Admissions of Black patients with AMI‐CA had longer length of hospital stay, higher rates of palliative care consultation, less frequent do‐not‐resuscitate status use, and fewer discharges to home (all P <0.001). Conclusions Racial and ethnic minorities received less frequent guideline‐directed procedures and had higher in‐hospital mortality and worse outcomes in AMI‐CA.

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“…The success of HBPM for BP control also depends on other factors such as patient-provider communication and sustained patient engagement with regular home monitoring. These factors can differ by race and ethnicity (Wisniewski & Walker, 2020;Woo et al, 2020), yet most minority populations are underrepresented-or entirely absent-from research on HBPM as a tool for managing hypertension (Uhlig et al, 2013). A 2017 systematic review and metaanalysis concluded that the overall effect of HBPM on BP control is heavily influenced by the presence and intensity of additional "co-interventions" such as antihypertensive medications and lifestyle modifications (Tucker et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Home Blood Pressure Monitoring Devices: Device Performance in an Alaska Native and American Indian Population

et al. 2021

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Objectives: Home blood pressure monitoring (HBPM) is an important component of blood pressure (BP) management. We assessed performance of two HBPM devices among Alaska Native and American Indian people (ANAIs). Methods: We measured BP using Omron BP786 arm cuff, Omron BP654 wrist cuff, and Baum aneroid sphygmomanometer in 100 ANAIs. Performance was assessed with intraclass correlation, paired t-tests, and calibration models. Results: Compared to sphygmomanometer, average BP was higher for wrist cuff (systolic = 4.8 mmHg and diastolic = 3.6 mmHg) and varied for arm cuff (systolic = −1.5 mmHg and diastolic = 2.5 mmHg). Calibration increased performance from grade B to A for arm cuff and from D to B for wrist cuff. Calibration increased false negatives and decreased false positives. Discussion: The arm HBPM device is more accurate than the wrist cuff among ANAIs with hypertension. Most patients are willing to use the arm cuff when accuracy is discussed.

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Racial Differences in the Utilization of Guideline-Recommended and Life-Sustaining Procedures During Hospitalizations for Out-of-Hospital Cardiac Arrest

Cited by 5 publications

References 34 publications

Social Factors Predictive of Intensive Care Utilization in Technology-Dependent Children, a Retrospective Multicenter Cohort Study

Social Factors Predictive of Intensive Care Utilization in Technology-Dependent Children, a Retrospective Multicenter Cohort Study

Racial and Ethnic Disparities in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction

Home Blood Pressure Monitoring Devices: Device Performance in an Alaska Native and American Indian Population

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