Arti D Desai1,2, Chuan Zhou1,2, Wren Haaland2, Jakobi Johnson3, K Casey Lion1,2, Michelle A Lopez4, Derek J Williams3, Chén C Kenyon5, Rita Mangione-Smith1,2, David P Johnson3. 1. Department of Pediatrics, University of Washington, Seattle, Washington. 2. Seattle Children's Research Institute, Seattle, Washington. 3. Division of Hospital Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Department of Pediatrics, Vanderbilt University School of Medicine, Nash-ville, Tennessee. 4. Department of Pediatrics, Baylor College of Medicine, Houston, Texas. 5. Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia and the Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Abstract
BACKGROUND AND OBJECTIVES: Understanding disparities in child health-related quality of life (HRQoL) may reveal opportunities for targeted improvement. This study examined associations between social disadvantage, access to care, and child physical functioning before and after hospitalization for acute respiratory illness. METHODS: From July 1, 2014, to June 30, 2016, children ages 8-16 years and/or caregivers of children 2 weeks to 16 years admitted to five tertiary care children's hospitals for three common respiratory illnesses completed a survey on admission and within 2 to 8 weeks after discharge. Survey items assessed social disadvantage (minority race/ ethnicity, limited English proficiency, low education, and low income), difficulty/delays accessing care, and baseline and follow-up HRQoL physical functioning using the Pediatric Quality of Life Inventory (PedsQL, range 0-100). We examined associations between these three variables at baseline and follow-up using multivariable, mixed-effects linear regression models with multiple imputation sensitivity analyses for missing data. RESULTS: A total of 1,325 patients and/or their caregivers completed both PedsQL assessments. Adjusted mean baseline PedsQL scores were significantly lower for patients with social disadvantage markers, compared with those of patients with none (78.7 for >3 markers versus 85.5 for no markers, difference -6.1 points (95% CI: -8.7, -3.5). The number of social disadvantage markers was not associated with mean follow-up PedsQL scores. Difficulty/delays accessing care were associated with lower PedsQL scores at both time points, but it was not a significant effect modifier between social disadvantage and PedsQL scores. CONCLUSIONS: Having social disadvantage markers or difficulty/delays accessing care was associated with lower baseline physical functioning; however, differences were reduced after hospital discharge.
BACKGROUND AND OBJECTIVES: Understanding disparities in child health-related quality of life (HRQoL) may reveal opportunities for targeted improvement. This study examined associations between social disadvantage, access to care, and child physical functioning before and after hospitalization for acute respiratory illness. METHODS: From July 1, 2014, to June 30, 2016, children ages 8-16 years and/or caregivers of children 2 weeks to 16 years admitted to five tertiary care children's hospitals for three common respiratory illnesses completed a survey on admission and within 2 to 8 weeks after discharge. Survey items assessed social disadvantage (minority race/ ethnicity, limited English proficiency, low education, and low income), difficulty/delays accessing care, and baseline and follow-up HRQoL physical functioning using the Pediatric Quality of Life Inventory (PedsQL, range 0-100). We examined associations between these three variables at baseline and follow-up using multivariable, mixed-effects linear regression models with multiple imputation sensitivity analyses for missing data. RESULTS: A total of 1,325 patients and/or their caregivers completed both PedsQL assessments. Adjusted mean baseline PedsQL scores were significantly lower for patients with social disadvantage markers, compared with those of patients with none (78.7 for >3 markers versus 85.5 for no markers, difference -6.1 points (95% CI: -8.7, -3.5). The number of social disadvantage markers was not associated with mean follow-up PedsQL scores. Difficulty/delays accessing care were associated with lower PedsQL scores at both time points, but it was not a significant effect modifier between social disadvantage and PedsQL scores. CONCLUSIONS: Having social disadvantage markers or difficulty/delays accessing care was associated with lower baseline physical functioning; however, differences were reduced after hospital discharge.
Authors: Andrew F Beck; Alicia J Cohen; Jeffrey D Colvin; Caroline M Fichtenberg; Eric W Fleegler; Arvin Garg; Laura M Gottlieb; Matthew S Pantell; Megan T Sandel; Adam Schickedanz; Robert S Kahn Journal: Pediatr Res Date: 2018-05-23 Impact factor: 3.756
Authors: Rita Mangione-Smith; Chuan Zhou; Derek J Williams; David P Johnson; Chén C Kenyon; Amy Tyler; Ricardo Quinonez; Joyee Vachani; Julie McGalliard; Joel S Tieder; Tamara D Simon; Karen M Wilson Journal: Pediatrics Date: 2019-08 Impact factor: 7.124
Authors: JoAnna K Leyenaar; Shawn L Ralston; Meng-Shiou Shieh; Penelope S Pekow; Rita Mangione-Smith; Peter K Lindenauer Journal: J Hosp Med Date: 2016-07-04 Impact factor: 2.960