Pediatric intensive care unit mortality among latino children before and after a multilevel health care delivery intervention

Kanwaljeet J.S. Anand, Robert J. Sepanski, Kimberley Giles, Samir Shah, Paul D. Juarez

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Importance: Research on health equity has focused on documenting health care disparities or understanding factors leading to disparities, but limited efforts have focused on reducing health care disparities in children. Latino children have increased prevalence of acute and chronic conditions; they have limited access and other barriers to high-quality health care, including intensive care. Objective: To determine whether pediatric intensive care unit mortality can be reduced by a multilevel health care delivery intervention.. Design, Setting, And Participants: Observational study of factors associated with pediatric intensive care unit mortality at a tertiary care metropolitan children's hospital in Memphis, Tennessee. Participants were children younger than 18 years discharged from the pediatricintensive care unit during the 3-year preintervention period of 2007 to 2009 (n = 3891) and 3-year postintervention period of 2010 to 2012 (n = 4179).. Interventions: Multilevel health care intervention to address the increased odds of mortality among Latino children.. Main Outcomes And Measures: The odds of mortalitywere analyzed over the 3-year preintervention period (2007-2009) using multivariable logistic regressions to control for age, sex, race/ethnicity, severity of illness, major diagnostic categories, diagnosed infections, and insurance status. Data from the postintervention period (2010-2012) were analyzed similarly to measure the effect of changes in health care delivery.. Results: Unadjusted mortality rates for white, African American, and Latino children in 2007 to 2009were 3.3%, 3.3%, and 8.6%, respectively. After controlling for covariates, no differences in the odds of mortalitywere observed between white children and African American children (odds ratio [OR], 1.0; 95%CI, 0.6-1.7; P = .97), but Latino children had 3.7-fold (95%CI, 1.8-7.5; P < .001) higher odds of mortality. A multilevel and multidisciplinary interventionwas launched to address these differences. In the postintervention period, unadjusted mortality rates for white, African American, and Latino childrenwere 3.6%, 3.2%, and 4.0%, respectively, with no differences observed after adjustment for covariates (OR, 0.7; 95%CI, 0.2-2.1; P = .49). The odds of mortality decreased between the preintervention period and postintervention period for Latino children (OR, 0.24; 95%CI, 0.06-0.88; P = .03) but remained unchanged for white and African American children (OR, 1.02; 95%CI, 0.73-1.43; P = .90).. Conclusions And Relevance: Latino children had higher odds of mortality, even after controlling for age, sex, severity of illness, insurance status, and other covariates. These differences disappeared after culturally and linguistically sensitive interventions at multiple levels. Local multilevel interventions can reduce the effect of health care inequities on clinical outcomes, without requiring major changes in health care policy..

Original languageEnglish (US)
Pages (from-to)383-390
Number of pages8
JournalJAMA Pediatrics
Volume169
Issue number4
DOIs
StatePublished - Apr 1 2015

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Pediatric Intensive Care Units
Hispanic Americans
Delivery of Health Care
Mortality
African Americans
Odds Ratio
Healthcare Disparities
Insurance Coverage
Quality of Health Care
Urban Hospitals
Tertiary Healthcare
Critical Care
Health Policy
Observational Studies
Logistic Models

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

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Pediatric intensive care unit mortality among latino children before and after a multilevel health care delivery intervention. / Anand, Kanwaljeet J.S.; Sepanski, Robert J.; Giles, Kimberley; Shah, Samir; Juarez, Paul D.

In: JAMA Pediatrics, Vol. 169, No. 4, 01.04.2015, p. 383-390.

Research output: Contribution to journalArticle

Anand, Kanwaljeet J.S. ; Sepanski, Robert J. ; Giles, Kimberley ; Shah, Samir ; Juarez, Paul D. / Pediatric intensive care unit mortality among latino children before and after a multilevel health care delivery intervention. In: JAMA Pediatrics. 2015 ; Vol. 169, No. 4. pp. 383-390.
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title = "Pediatric intensive care unit mortality among latino children before and after a multilevel health care delivery intervention",
abstract = "Importance: Research on health equity has focused on documenting health care disparities or understanding factors leading to disparities, but limited efforts have focused on reducing health care disparities in children. Latino children have increased prevalence of acute and chronic conditions; they have limited access and other barriers to high-quality health care, including intensive care. Objective: To determine whether pediatric intensive care unit mortality can be reduced by a multilevel health care delivery intervention.. Design, Setting, And Participants: Observational study of factors associated with pediatric intensive care unit mortality at a tertiary care metropolitan children's hospital in Memphis, Tennessee. Participants were children younger than 18 years discharged from the pediatricintensive care unit during the 3-year preintervention period of 2007 to 2009 (n = 3891) and 3-year postintervention period of 2010 to 2012 (n = 4179).. Interventions: Multilevel health care intervention to address the increased odds of mortality among Latino children.. Main Outcomes And Measures: The odds of mortalitywere analyzed over the 3-year preintervention period (2007-2009) using multivariable logistic regressions to control for age, sex, race/ethnicity, severity of illness, major diagnostic categories, diagnosed infections, and insurance status. Data from the postintervention period (2010-2012) were analyzed similarly to measure the effect of changes in health care delivery.. Results: Unadjusted mortality rates for white, African American, and Latino children in 2007 to 2009were 3.3{\%}, 3.3{\%}, and 8.6{\%}, respectively. After controlling for covariates, no differences in the odds of mortalitywere observed between white children and African American children (odds ratio [OR], 1.0; 95{\%}CI, 0.6-1.7; P = .97), but Latino children had 3.7-fold (95{\%}CI, 1.8-7.5; P < .001) higher odds of mortality. A multilevel and multidisciplinary interventionwas launched to address these differences. In the postintervention period, unadjusted mortality rates for white, African American, and Latino childrenwere 3.6{\%}, 3.2{\%}, and 4.0{\%}, respectively, with no differences observed after adjustment for covariates (OR, 0.7; 95{\%}CI, 0.2-2.1; P = .49). The odds of mortality decreased between the preintervention period and postintervention period for Latino children (OR, 0.24; 95{\%}CI, 0.06-0.88; P = .03) but remained unchanged for white and African American children (OR, 1.02; 95{\%}CI, 0.73-1.43; P = .90).. Conclusions And Relevance: Latino children had higher odds of mortality, even after controlling for age, sex, severity of illness, insurance status, and other covariates. These differences disappeared after culturally and linguistically sensitive interventions at multiple levels. Local multilevel interventions can reduce the effect of health care inequities on clinical outcomes, without requiring major changes in health care policy..",
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T1 - Pediatric intensive care unit mortality among latino children before and after a multilevel health care delivery intervention

AU - Anand, Kanwaljeet J.S.

AU - Sepanski, Robert J.

AU - Giles, Kimberley

AU - Shah, Samir

AU - Juarez, Paul D.

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Importance: Research on health equity has focused on documenting health care disparities or understanding factors leading to disparities, but limited efforts have focused on reducing health care disparities in children. Latino children have increased prevalence of acute and chronic conditions; they have limited access and other barriers to high-quality health care, including intensive care. Objective: To determine whether pediatric intensive care unit mortality can be reduced by a multilevel health care delivery intervention.. Design, Setting, And Participants: Observational study of factors associated with pediatric intensive care unit mortality at a tertiary care metropolitan children's hospital in Memphis, Tennessee. Participants were children younger than 18 years discharged from the pediatricintensive care unit during the 3-year preintervention period of 2007 to 2009 (n = 3891) and 3-year postintervention period of 2010 to 2012 (n = 4179).. Interventions: Multilevel health care intervention to address the increased odds of mortality among Latino children.. Main Outcomes And Measures: The odds of mortalitywere analyzed over the 3-year preintervention period (2007-2009) using multivariable logistic regressions to control for age, sex, race/ethnicity, severity of illness, major diagnostic categories, diagnosed infections, and insurance status. Data from the postintervention period (2010-2012) were analyzed similarly to measure the effect of changes in health care delivery.. Results: Unadjusted mortality rates for white, African American, and Latino children in 2007 to 2009were 3.3%, 3.3%, and 8.6%, respectively. After controlling for covariates, no differences in the odds of mortalitywere observed between white children and African American children (odds ratio [OR], 1.0; 95%CI, 0.6-1.7; P = .97), but Latino children had 3.7-fold (95%CI, 1.8-7.5; P < .001) higher odds of mortality. A multilevel and multidisciplinary interventionwas launched to address these differences. In the postintervention period, unadjusted mortality rates for white, African American, and Latino childrenwere 3.6%, 3.2%, and 4.0%, respectively, with no differences observed after adjustment for covariates (OR, 0.7; 95%CI, 0.2-2.1; P = .49). The odds of mortality decreased between the preintervention period and postintervention period for Latino children (OR, 0.24; 95%CI, 0.06-0.88; P = .03) but remained unchanged for white and African American children (OR, 1.02; 95%CI, 0.73-1.43; P = .90).. Conclusions And Relevance: Latino children had higher odds of mortality, even after controlling for age, sex, severity of illness, insurance status, and other covariates. These differences disappeared after culturally and linguistically sensitive interventions at multiple levels. Local multilevel interventions can reduce the effect of health care inequities on clinical outcomes, without requiring major changes in health care policy..

AB - Importance: Research on health equity has focused on documenting health care disparities or understanding factors leading to disparities, but limited efforts have focused on reducing health care disparities in children. Latino children have increased prevalence of acute and chronic conditions; they have limited access and other barriers to high-quality health care, including intensive care. Objective: To determine whether pediatric intensive care unit mortality can be reduced by a multilevel health care delivery intervention.. Design, Setting, And Participants: Observational study of factors associated with pediatric intensive care unit mortality at a tertiary care metropolitan children's hospital in Memphis, Tennessee. Participants were children younger than 18 years discharged from the pediatricintensive care unit during the 3-year preintervention period of 2007 to 2009 (n = 3891) and 3-year postintervention period of 2010 to 2012 (n = 4179).. Interventions: Multilevel health care intervention to address the increased odds of mortality among Latino children.. Main Outcomes And Measures: The odds of mortalitywere analyzed over the 3-year preintervention period (2007-2009) using multivariable logistic regressions to control for age, sex, race/ethnicity, severity of illness, major diagnostic categories, diagnosed infections, and insurance status. Data from the postintervention period (2010-2012) were analyzed similarly to measure the effect of changes in health care delivery.. Results: Unadjusted mortality rates for white, African American, and Latino children in 2007 to 2009were 3.3%, 3.3%, and 8.6%, respectively. After controlling for covariates, no differences in the odds of mortalitywere observed between white children and African American children (odds ratio [OR], 1.0; 95%CI, 0.6-1.7; P = .97), but Latino children had 3.7-fold (95%CI, 1.8-7.5; P < .001) higher odds of mortality. A multilevel and multidisciplinary interventionwas launched to address these differences. In the postintervention period, unadjusted mortality rates for white, African American, and Latino childrenwere 3.6%, 3.2%, and 4.0%, respectively, with no differences observed after adjustment for covariates (OR, 0.7; 95%CI, 0.2-2.1; P = .49). The odds of mortality decreased between the preintervention period and postintervention period for Latino children (OR, 0.24; 95%CI, 0.06-0.88; P = .03) but remained unchanged for white and African American children (OR, 1.02; 95%CI, 0.73-1.43; P = .90).. Conclusions And Relevance: Latino children had higher odds of mortality, even after controlling for age, sex, severity of illness, insurance status, and other covariates. These differences disappeared after culturally and linguistically sensitive interventions at multiple levels. Local multilevel interventions can reduce the effect of health care inequities on clinical outcomes, without requiring major changes in health care policy..

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