Child Opportunity Index and Rehospitalization for Ambulatory Care Sensitive Conditions at US Children's Hospitals.

Autor:	Parikh K; Division of Hospital Medicine, Children's National Hospital, Washington, DC., Lopez MA; Department of Pediatrics, Baylor College of Medicine, Houston, Texas., Hall M; Children's Hospital Association, Lenexa, Kansas., Bettenhausen J; Division of Pediatric Hospital Medicine, Children's Mercy - Kansas City, Kansas City, Missouri University of Missouri - Kansas City, Kansas City, Missouri., Sills MR; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado., Hoffmann J; Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.; Feinberg School of Medicine, Northwestern University, Chicago, Illinois., Morse R; The Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, Ohio., Shah SS; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio., Noelke C; Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts., Kaiser SV; Department of Pediatrics, University of California, San Francisco, California.; Philip R. Lee Institute for Health Policy Studies, San Francisco, California.
Jazyk:	angličtina
Zdroj:	Hospital pediatrics [Hosp Pediatr] 2023 Nov 01; Vol. 13 (11), pp. 1028-1037.
DOI:	10.1542/hpeds.2023-007279
Abstrakt:	Objective: Child Opportunity Index (COI) measures neighborhood contextual factors (education, health and environment, social and economic) that may influence child health. Such factors have been associated with hospitalizations for ambulatory care sensitive conditions (ACSC). Lower COI has been associated with higher health care utilization, yet association with rehospitalization(s) for ACSC remains unknown. Our objective is to determine the association between COI and ACSC rehospitalizations. Methods: Multicenter retrospective cohort study of children ages 0 to 17 years with a hospital admission for ambulatory care sensitive conditions in 2017 or 2018. Exposure was COI. Outcome was rehospitalization within 1 year of index admission (analyzed as any or ≥2 rehospitalization) for ACSC. Logistic regression models adjusted for age, sex, severity, and complex and mental health conditions. Results: The study included 184 478 children. Of hospitalizations, 28.3% were by children from very low COI and 16.5% were by children from very high COI neighborhoods. In risk-adjusted models, ACSC rehospitalization was higher for children from very low COI than very high COI neighborhoods; any rehospitalization occurred for 18.7% from very low COI and 13.5% from very high COI neighborhoods (adjusted odds ratio 1.14 [1.05-1.23]), whereas ≥2 rehospitalization occurred for 4.8% from very low COI and 3.2% from very high COI neighborhoods (odds ratio 1.51 [1.29-1.75]). Conclusions: Children from neighborhoods with low COI had higher rehospitalizations for ACSCs. Further research is needed to understand how hospital systems can address social determinants of health in the communities they serve to prevent rehospitalizations. (Copyright © 2023 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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