The Association of the Childhood Opportunity Index on Pediatric Readmissions and Emergency Department Revisits

• Type of Material: Article
• Authors: Jessica L Bettenhausen, Childrens Mercy Kansas City; Clemens Noelke, Brandeis University; Robert W Ressler, Brandeis University; Matthew Hall, Children’s Hospital Association; Mitch Harris, Children’s Hospital Association; Alon Peltz, Harvard Medical School; Katherine A Auger, University of Cincinnati; Ronald J Teufel, Medical University of South Carolina; Jeffrey E Lutmer, Nationwide Childrens Hospital; Molly K Krager, Childrens Mercy Kansas City; Harold Simon, Emory University; Mark Neuman, Harvard Medical School; Padmaja Pavuluri, Children’s National Hospital, Washington; Rustin B Morse, Ohio State University; Pirooz Eghtesady, Washington University in St Louis and Heart Center, St Louis Children’s Hospital; Michelle L Macy, Northwestern University; Samir S Shah, University of Cincinnati; David C Synhorst, Childrens Mercy Kansas City; James C Gay, Vanderbilt University
• Language: English
• Date: 2022-05-02
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 by Academic Pediatric Association
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.acap.2021.12.015
• Title of Journal or Parent Work: ACADEMIC PEDIATRICS
• Volume: 22
• Issue: 4
• Start Page: 614
• End Page: 621
• Grant/Funding Information: Dr. Eghetsady is supported by the Emerson Corporation.; Dr. Peltz’s effort was supported by the National Heart Lung and Blood Institute [K23HL155425-01].; Drs. Noelke and Ressler gratefully acknowledge funding provided by the W. K. Kellogg Foundation and the Robert Wood Johnson Foundation.; The other authors received no external funding.
• Keywords: reutilization; RATES; IMPACT; SOCIOECONOMIC-STATUS; DISPARITIES; PREVENTABLE READMISSIONS; social determinants of health; readmissions; Science & Technology; Life Sciences & Biomedicine; Pediatrics

Abstract

Objective: Reutilization following discharge is costly to families and the health care system. Singular measures of the social determinants of health (SDOH) have been shown to impact utilization; however, the SDOH are multifactorial. The Childhood Opportunity Index (COI) is a validated approach for comprehensive estimation of the SDOH. Using the COI, we aimed to describe the association between SDOH and 30-day revisit rates. Methods: This retrospective study included children 0 to 17 years within 48 children's hospitals using the Pediatric Health Information System from 1/1/2019 to 12/31/2019. The main exposure was a child's ZIP code level COI. The primary outcome was unplanned readmissions and emergency department (ED) revisits within 30 days of discharge. Primary outcomes were summarized by COI category and compared using chi-square or Kruskal-Wallis tests. Adjusted analysis used generalized linear mixed effects models with adjustments for demographics, clinical characteristics, and hospital clustering. Results: Of 728,997 hospitalizations meeting inclusion criteria, 30-day unplanned returns occurred for 96,007 children (13.2%). After adjustment, the patterns of returns were significantly associated with COI. For example, 30-day returns occurred for 19.1% (95% confidence interval [CI]: 18.2, 20.0) of children living within very low opportunity areas, with a gradient-like decrease as opportunity increased (15.5%, 95% CI: 14.5, 16.5 for very high). The relative decrease in utilization as COI increased was more pronounced for ED revisits. Conclusions: Children living in low opportunity areas had greater 30-day readmissions and ED revisits. Our results suggest that a broader approach, including policy and system-level change, is needed to effectively reduce readmissions and ED revisits.