Molly K Krager1, Henry T Puls2, Jessica L Bettenhausen2, Matt Hall2,3, Cary Thurm3, Laura M Plencner2, Jessica L Markham2, Clemens Noelke4, Andrew F Beck5. 1. Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri mkkrager@cmh.edu. 2. Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri. 3. Children's Hospital Association, Lenexa, Kansas. 4. The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. 5. Department of Pediatrics, Cincinnati Children's Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio.
Abstract
BACKGROUND AND OBJECTIVES: Hospitalizations for ambulatory care sensitive conditions (ACSCs) are thought to be avoidable with high-quality outpatient care. Morbidity related to ACSCs has been associated with socioeconomic contextual factors, which do not necessarily capture the complex pathways through which a child's environment impacts health outcomes. Our primary objective was to test the association between a multidimensional measure of neighborhood-level child opportunity and pediatric hospitalization rates for ACSCs across 2 metropolitan areas. METHODS: This was a retrospective population-based analysis of ACSC hospitalizations within the Kansas City and Cincinnati metropolitan areas from 2013 to 2018. Census tracts were included if located in a county where Children's Mercy Kansas City or Cincinnati Children's Hospital Medical Center had >80% market share of hospitalizations for children <18 years. Our predictor was child opportunity as defined by a composite index, the Child Opportunity Index 2.0. Our outcome was hospitalization rates for 8 ACSCs. RESULTS: We included 604 943 children within 628 census tracts. There were 26 977 total ACSC hospitalizations (46 hospitalizations per 1000 children; 95% confidence interval [CI]: 45.4-46.5). The hospitalization rate for all ACSCs revealed a stepwise reduction from 79.9 per 1000 children (95% CI: 78.1-81.7) in very low opportunity tracts to 31.2 per 1000 children (95% CI: 30.5-32.0) in very high opportunity tracts (P < .001). This trend was observed across cities and diagnoses. CONCLUSIONS: Links between ACSC hospitalizations and child opportunity extend across metropolitan areas. Targeting interventions to lower-opportunity neighborhoods and enacting policies that equitably bolster opportunity may improve child health outcomes, reduce inequities, and decrease health care costs.
BACKGROUND AND OBJECTIVES: Hospitalizations for ambulatory care sensitive conditions (ACSCs) are thought to be avoidable with high-quality outpatient care. Morbidity related to ACSCs has been associated with socioeconomic contextual factors, which do not necessarily capture the complex pathways through which a child's environment impacts health outcomes. Our primary objective was to test the association between a multidimensional measure of neighborhood-level child opportunity and pediatric hospitalization rates for ACSCs across 2 metropolitan areas. METHODS: This was a retrospective population-based analysis of ACSC hospitalizations within the Kansas City and Cincinnati metropolitan areas from 2013 to 2018. Census tracts were included if located in a county where Children's Mercy Kansas City or Cincinnati Children's Hospital Medical Center had >80% market share of hospitalizations for children <18 years. Our predictor was child opportunity as defined by a composite index, the Child Opportunity Index 2.0. Our outcome was hospitalization rates for 8 ACSCs. RESULTS: We included 604 943 children within 628 census tracts. There were 26 977 total ACSC hospitalizations (46 hospitalizations per 1000 children; 95% confidence interval [CI]: 45.4-46.5). The hospitalization rate for all ACSCs revealed a stepwise reduction from 79.9 per 1000 children (95% CI: 78.1-81.7) in very low opportunity tracts to 31.2 per 1000 children (95% CI: 30.5-32.0) in very high opportunity tracts (P < .001). This trend was observed across cities and diagnoses. CONCLUSIONS: Links between ACSC hospitalizations and child opportunity extend across metropolitan areas. Targeting interventions to lower-opportunity neighborhoods and enacting policies that equitably bolster opportunity may improve child health outcomes, reduce inequities, and decrease health care costs.
Authors: Cristin Q Fritz; Matt Hall; Jessica L Bettenhausen; Andrew F Beck; Molly K Krager; Katherine L Freundlich; Dena Ibrahim; Joanna E Thomson; James C Gay; Alison R Carroll; Maya Neeley; Patricia A Frost; Alison C Herndon; Allysa L Kehring; Derek J Williams Journal: J Hosp Med Date: 2022-03-16 Impact factor: 2.899
Authors: Jessica L Bettenhausen; Clemens Noelke; Robert W Ressler; Matthew Hall; Mitch Harris; Alon Peltz; Katherine A Auger; Ronald J Teufel; Jeffrey E Lutmer; Molly K Krager; Harold K Simon; Mark I Neuman; Padmaja Pavuluri; Rustin B Morse; Pirooz Eghtesady; Michelle L Macy; Samir S Shah; David C Synhorst; James C Gay Journal: Acad Pediatr Date: 2021-12-17 Impact factor: 2.993
Authors: Kelly R Bergmann; Amanda Nickel; Matt Hall; Gretchen Cutler; M Jennifer Abuzzahab; Brianna Bretscher; Shea Lammers; Dave Watson; Gabrielle Z Hester Journal: JAMA Netw Open Date: 2022-05-02