Identifying Modifiable Health Care Barriers to Improve Health Equity for Hospitalized Children.
Identifying Modifiable Health Care Barriers to Improve Health Equity for Hospitalized Children.
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DOI：
10.1542/hpeds.2019-0096
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发表时间：
2020-01-01
影响因子：
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通讯作者：
Mangione-Smith, Rita
中科院分区：
文献类型：
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作者：
Lion, K Casey;Zhou, Chuan;Mangione-Smith, Rita
背景：与其他儿童相比，来自社会弱势家庭的儿童经历了更糟糕的住院结果。方法：我们对15个月以上的住院儿童进行了一项前瞻性队列研究。照顾者在入院后3天和出院后2至8周内完成了一项调查，以评估与他们在医疗保健系统中的互动有关的10个报告的护理障碍(例如，感觉他们没有足够的技能来驾驭系统并经历边缘化)。障碍与结果(30天再入院时间和住院时间)之间的关联通过多变量回归进行评估。结果：在符合条件的家庭中，61%(n=3651)的家庭完成了入院调查；其中48%(n=1734)完成了随访。10个障碍中有9个与至少1个更差的住院结果相关。其中，4项与累积的社会劣势呈正相关：将系统视为障碍(调整后的Beta=1.66；95%可信区间[CI]1.02至2.30)、技能障碍(Beta=3.82；95%CI为3.22至4.43)、文化距离(Beta=1.75；95%CI为1.36至2.15)以及边缘化(Beta=0.71；95%CI为0.30至1.11)。低收入与报告障碍的相关性最强。结论：制度障碍、技能障碍、文化距离和边缘化与较差的医院结局和社会劣势显著相关，这表明这些是减少住院儿童差异的有希望的干预目标。
BACKGROUND: Children from socially disadvantaged families experience worse hospital outcomes compared with other children. We sought to identify modifiable barriers to care to target for intervention.METHODS: We conducted a prospective cohort study of hospitalized children over 15 months. Caregivers completed a survey within 3 days of admission and 2 to 8 weeks after discharge to assess 10 reported barriers to care related to their interactions within the health care system (eg, not feeling like they have sufficient skills to navigate the system and experiencing marginalization). Associations between barriers and outcomes (30-day readmissions and length of stay) were assessed by using multivariable regression. Barriers associated with worse outcomes were then tested for associations with a cumulative social disadvantage score based on 5 family sociodemographic characteristics (eg, low income).RESULTS: Of eligible families, 61% (n = 3651) completed the admission survey; of those, 48% (n = 1734) completed follow-up. Nine of 10 barriers were associated with at least 1 worse hospital outcome. Of those, 4 were also positively associated with cumulative social disadvantage: perceiving the system as a barrier (adjusted beta = 1.66; 95% confidence interval [CI] 1.02 to 2.30), skill barriers (beta = 3.82; 95% CI 3.22 to 4.43), cultural distance (beta = 1.75; 95% CI 1.36 to 2.15), and marginalization (beta = .71; 95% CI 0.30 to 1.11). Low income had the most consistently strong association with reported barriers.CONCLUSIONS: System barriers, skill barriers, cultural distance, and marginalization were significantly associated with both worse hospital outcomes and social disadvantage, suggesting these are promising targets for intervention to decrease disparities for hospitalized children.