Association between Unmet Social Need and Ambulatory Quality of Care for US Children.

IF 3 3区医学 Q1 PEDIATRICS Academic Pediatrics Pub Date : 2024-10-17 DOI:10.1016/j.acap.2024.10.001

Alexandra T Geanacopoulos, Claire Branley, Arvin Garg, Margaret E Samuels-Kalow, Jonathan M Gabbay, Alon Peltz

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Abstract

Objectives: Children who experience socioeconomic adversity often have worse health; however, less is known about their quality of care. We sought to evaluate the association between parent/caregiver-reported socioeconomic adversity and quality of pediatric primary, acute, and chronic ambulatory care on a national level.

Methods: This was a retrospective cohort study of 5368 representative US children (1-17 years) in the 2021 Medical Expenditure Panel Survey. Socioeconomic adversity was defined as parent/caregiver-reported food, housing, transportation, or utility insecurity in the past 12 months. Outcomes included 10 quality measures of primary, acute, and chronic care, and experience of care measured through parent/caregiver survey. We described variation in socioeconomic adversity and used multivariable regression to examine associations with quality outcomes.

Results: One-third of parent/caregivers reported socioeconomic adversity. Food insecurity (23.6%) was most common followed by utility (19.5%), housing (15.0%), and transportation (4.7%) insecurity. Black (53.2%) and Hispanic (46.9%) parent/caregivers experienced the highest rates of socioeconomic adversity. Children with socioeconomic adversity received lower quality of care for four quality measures, including more frequent Emergency Department visits (Odds Ratio (OR)= 1.69 [95% Confidence Interval (CI): 1.28-2.23]), less favorable asthma medication ratio (OR=0.04 [95% CI: 0.01-0.31]), and less frequent well child (OR=0.73 [95% CI: 0.59-0.90]) and dental care (OR=0.76 [95% CI: 0.63-0.94], P < .05 for all). There were no statistically significant differences in experience of care.

Conclusions: Socioeconomic adversity is common among US children with disproportionate impact on Black and Hispanic families. There are significant disparities in pediatric primary, acute, and chronic care quality, based on parent/caregiver-reported socioeconomic adversity, highlighting the need for systems-level interventions.

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未满足的社会需求与美国儿童门诊护理质量之间的关系。

目的：处于社会经济逆境中的儿童通常健康状况较差；然而，人们对他们的医疗质量却知之甚少。我们试图在全国范围内评估家长/护理人员报告的社会经济逆境与儿科初级、急性和慢性门诊护理质量之间的关系：这是一项回顾性队列研究，研究对象是 2021 年医疗支出小组调查中具有代表性的 5368 名美国儿童（1-17 岁）。社会经济逆境的定义是父母/照顾者报告的过去 12 个月中的食物、住房、交通或公用事业不安全状况。结果包括初级、急性和慢性护理的 10 项质量测量，以及通过家长/护理人员调查测量的护理体验。我们描述了社会经济逆境的变化，并使用多元回归法研究了与质量结果之间的关联：三分之一的家长/护理人员报告了社会经济逆境。食品不安全（23.6%）最常见，其次是公用事业（19.5%）、住房（15.0%）和交通（4.7%）不安全。黑人（53.2%）和西班牙裔（46.9%）家长/照顾者的社会经济逆境发生率最高。处于社会经济逆境的儿童在 4 项质量衡量标准中获得的护理质量较低，包括更频繁的急诊室就诊（Odds Ratio (OR)=1.69 [95% Confidence Interval (CI):1.28-2.23]）、较差的哮喘用药比率（OR=0.04 [95%CI:0.01-0.31]）、较少的儿童保健（OR=0.73 [95%CI:0.59-0.90]）和牙科护理（OR=0.76 [95%CI:0.63-0.94]，P 结论：社会经济逆境在美国儿童中很常见，对黑人和西班牙裔家庭的影响尤为严重。根据家长/护理人员报告的社会经济逆境，儿科初级、急性和慢性病护理质量存在明显差异，这凸显了在系统层面进行干预的必要性。

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来源期刊

Academic Pediatrics PEDIATRICS-

CiteScore

4.60

自引率

12.90%

发文量

300

审稿时长

60 days

期刊介绍： Academic Pediatrics, the official journal of the Academic Pediatric Association, is a peer-reviewed publication whose purpose is to strengthen the research and educational base of academic general pediatrics. The journal provides leadership in pediatric education, research, patient care and advocacy. Content areas include pediatric education, emergency medicine, injury, abuse, behavioral pediatrics, holistic medicine, child health services and health policy,and the environment. The journal provides an active forum for the presentation of pediatric educational research in diverse settings, involving medical students, residents, fellows, and practicing professionals. The journal also emphasizes important research relating to the quality of child health care, health care policy, and the organization of child health services. It also includes systematic reviews of primary care interventions and important methodologic papers to aid research in child health and education.