Anita N Shah1,2,3, Katherine A Auger1,4,3, Heidi J Sucharew5,3, Colleen Mangeot5,3, Kelsey Childress6, Julianne Haney7, Samir S Shah1,4,8,3, Jeffrey M Simmons1,4,3, Andrew F Beck1,4,9,3. 1. Division of Hospital Medicine, Cincinnnati Children's Hospital Medical Center, Cincinnati, Ohio. 2. Mayerson Center for Safe and Healthy Children, Cincinnnati Children's Hospital Medical Center, Cincinnati, Ohio. 3. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio. 4. James M. Anderson Center for Health Systems System Excellence, Cincinnnati Children's Hospital Medical Center, Cincinnati, Ohio. 5. Biostatistics and Epidemiology, Cincinnnati Children's Hospital Medical Center, Cincinnati, Ohio. 6. Division of Hospital Medicine, Department of Pediatrics, Kaiser South Sacramento, Sacramento, California. 7. College of Medicine, University of Cincinnati, Cincinnati, Ohio. 8. Division of Infectious Diseases, Cincinnnati Children's Hospital Medical Center, Cincinnati, Ohio. 9. General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Abstract
BACKGROUND: Adverse childhood experiences (ACEs) are associated with poor health outcomes in adults. Resilience may mitigate this effect. There is limited evidence regarding how parents' ACEs and resilience may be associated with their children's health outcomes. OBJECTIVE: To determine the association of parental ACEs and resilience with their child's risk of unanticipated healthcare reutilization. DESIGN, SETTING, AND PARTICIPANTS: We conducted a prospective cohort study (August 2015 to October 2016) at a tertiary, freestanding pediatric medical center in Cincinnati, Ohio. Eligible participants were English-speaking parents of children hospitalized on a Hospital Medicine or Complex Services team. A total of 1,320 parents of hospitalized children completed both the ACE questionnaire and the Brief Resilience Scale Survey. EXPOSURE: Number of ACEs and Brief Resilience Scale Score among parents. MAIN OUTCOMES: Unanticipated reutilization by children, defined as returning to the emergency room, urgent care, or being readmitted to the hospital within 30 days of hospital discharge. RESULTS: In adjusted analyses, children of parents with 4 or more ACEs had 1.69-times higher odds (95% CI, 1.11-2.60) of unanticipated reutilization after an index hospitalization, compared with children of parents with no ACEs. Resilience was not significantly associated with reutilization. CONCLUSION: Parental history of ACEs is strongly associated with higher odds of their child having unanticipated healthcare reutilization after a hospital discharge, highlighting an intergenerational effect. Screening may be an important tool for outcome prediction and intervention guidance following pediatric hospitalization.
BACKGROUND: Adverse childhood experiences (ACEs) are associated with poor health outcomes in adults. Resilience may mitigate this effect. There is limited evidence regarding how parents' ACEs and resilience may be associated with their children's health outcomes. OBJECTIVE: To determine the association of parental ACEs and resilience with their child's risk of unanticipated healthcare reutilization. DESIGN, SETTING, AND PARTICIPANTS: We conducted a prospective cohort study (August 2015 to October 2016) at a tertiary, freestanding pediatric medical center in Cincinnati, Ohio. Eligible participants were English-speaking parents of children hospitalized on a Hospital Medicine or Complex Services team. A total of 1,320 parents of hospitalized children completed both the ACE questionnaire and the Brief Resilience Scale Survey. EXPOSURE: Number of ACEs and Brief Resilience Scale Score among parents. MAIN OUTCOMES: Unanticipated reutilization by children, defined as returning to the emergency room, urgent care, or being readmitted to the hospital within 30 days of hospital discharge. RESULTS: In adjusted analyses, children of parents with 4 or more ACEs had 1.69-times higher odds (95% CI, 1.11-2.60) of unanticipated reutilization after an index hospitalization, compared with children of parents with no ACEs. Resilience was not significantly associated with reutilization. CONCLUSION: Parental history of ACEs is strongly associated with higher odds of their child having unanticipated healthcare reutilization after a hospital discharge, highlighting an intergenerational effect. Screening may be an important tool for outcome prediction and intervention guidance following pediatric hospitalization.
Authors: Alonzo T Folger; Emily A Eismann; Nicole B Stephenson; Robert A Shapiro; Maurizio Macaluso; Maggie E Brownrigg; Robert J Gillespie Journal: Pediatrics Date: 2018-04 Impact factor: 7.124
Authors: V J Felitti; R F Anda; D Nordenberg; D F Williamson; A M Spitz; V Edwards; M P Koss; J S Marks Journal: Am J Prev Med Date: 1998-05 Impact factor: 5.043