Social Factors Predictive of Intensive Care Utilization in Technology-Dependent Children, a Retrospective Multicenter Cohort Study
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...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-09-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2021.721353/full |
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| author | Katherine N. Slain Katherine N. Slain Amie Barda Peter J. Pronovost Peter J. Pronovost J. Daryl Thornton J. Daryl Thornton J. Daryl Thornton |
| author_facet | Katherine N. Slain Katherine N. Slain Amie Barda Peter J. Pronovost Peter J. Pronovost J. Daryl Thornton J. Daryl Thornton J. Daryl Thornton |
| author_sort | Katherine N. Slain |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-22T10:12:33Z |
| format | Article |
| id | doaj.art-1c95ad8bdda246fdac787e02f8a6e84c |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-22T10:12:33Z |
| publishDate | 2021-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-1c95ad8bdda246fdac787e02f8a6e84c2022-12-21T18:29:48ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602021-09-01910.3389/fped.2021.721353721353Social Factors Predictive of Intensive Care Utilization in Technology-Dependent Children, a Retrospective Multicenter Cohort StudyKatherine N. Slain0Katherine N. Slain1Amie Barda2Peter J. Pronovost3Peter J. Pronovost4J. Daryl Thornton5J. Daryl Thornton6J. Daryl Thornton7Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, United StatesCase Western Reserve University School of Medicine, Cleveland, OH, United StatesDepartment of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, United StatesCase Western Reserve University School of Medicine, Cleveland, OH, United StatesDepartment of Anesthesiology and Critical Care Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, United StatesCase Western Reserve University School of Medicine, Cleveland, OH, United StatesCenter for Reducing Health Disparities, MetroHealth Campus of Case Western Reserve University, Cleveland, OH, United StatesCenter for Population Health Research, MetroHealth Campus of Case Western Reserve University, Cleveland, OH, United StatesObjective: 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.https://www.frontiersin.org/articles/10.3389/fped.2021.721353/fullhealthcare disparitiesintensive care unitspediatrictracheostomygastrostomyrace |
| spellingShingle | Katherine N. Slain Katherine N. Slain Amie Barda Peter J. Pronovost Peter J. Pronovost J. Daryl Thornton J. Daryl Thornton J. Daryl Thornton Social Factors Predictive of Intensive Care Utilization in Technology-Dependent Children, a Retrospective Multicenter Cohort Study Frontiers in Pediatrics healthcare disparities intensive care units pediatric tracheostomy gastrostomy race |
| title | Social Factors Predictive of Intensive Care Utilization in Technology-Dependent Children, a Retrospective Multicenter Cohort Study |
| title_full | Social Factors Predictive of Intensive Care Utilization in Technology-Dependent Children, a Retrospective Multicenter Cohort Study |
| title_fullStr | Social Factors Predictive of Intensive Care Utilization in Technology-Dependent Children, a Retrospective Multicenter Cohort Study |
| title_full_unstemmed | Social Factors Predictive of Intensive Care Utilization in Technology-Dependent Children, a Retrospective Multicenter Cohort Study |
| title_short | Social Factors Predictive of Intensive Care Utilization in Technology-Dependent Children, a Retrospective Multicenter Cohort Study |
| title_sort | social factors predictive of intensive care utilization in technology dependent children a retrospective multicenter cohort study |
| topic | healthcare disparities intensive care units pediatric tracheostomy gastrostomy race |
| url | https://www.frontiersin.org/articles/10.3389/fped.2021.721353/full |
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