Association of Socioeconomic Status With Postdischarge Pediatric Resource Use and Quality of Life. Crit Care Med 2022 Feb 01;50(2):e117-e128
Date
09/09/2021Pubmed ID
34495879Pubmed Central ID
PMC8810731DOI
10.1097/CCM.0000000000005261Scopus ID
2-s2.0-85123970002 (requires institutional sign-in at Scopus site) 6 CitationsAbstract
OBJECTIVES: Socioeconomic factors may impact healthcare resource use and health-related quality of life, but their association with postcritical illness outcomes is unknown. This study examines the associations between socioeconomic status, resource use, and health-related quality of life in a cohort of children recovering from acute respiratory failure.
DESIGN: Secondary analysis of data from the Randomized Evaluation of Sedation Titration for Respiratory Failure clinical trial.
SETTING: Thirty-one PICUs.
PATIENTS: Children with acute respiratory failure enrolled whose parent/guardians consented for follow-up.
MEASUREMENTS AND MAIN RESULTS: Resource use included in-home care, number of healthcare providers, prescribed medications, home medical equipment, emergency department visits, and hospital readmission. Socioeconomic status was estimated by matching residential address to census tract-based median income. Health-related quality of life was measured using age-based parent-report instruments. Resource use interviews with matched census tract data (n = 958) and health-related quality of life questionnaires (n = 750/958) were assessed. Compared with high-income children, low-income children received care from fewer types of healthcare providers (β = -0.4; p = 0.004), used less newly prescribed medical equipment (odds ratio = 0.4; p < 0.001), and had more emergency department visits (43% vs 33%; p = 0.04). In the youngest cohort (< 2 yr old), low-income children had lower quality of life scores from physical ability (-8.6 points; p = 0.01) and bodily pain/discomfort (+8.2 points; p < 0.05). In addition, health-related quality of life was lower in those who had more healthcare providers and prescribed medications. In older children, health-related quality of life was lower if they had prescribed medications, emergency department visits, or hospital readmission.
CONCLUSIONS: Children recovering from acute respiratory failure have ongoing healthcare resource use. Yet, lower income children use less in-home and outpatient services and use more hospital resources. Continued follow-up care, especially in lower income children, may help identify those in need of ongoing healthcare resources and those at-risk for decreased health-related quality of life.
Author List
Kachmar AG, Watson RS, Wypij D, Perry MA, Curley MAQ, for the Randomized Evaluation of Sedation Titration for Respiratory Failure ( RESTORE ) Investigative TeamAuthor
Rainer G. Gedeit MD Associate Chief Medical Officer in the Children's Administration department at Children's WisconsinMESH terms used to index this publication - Major topics in bold
ChildChild, Preschool
Female
Health Resources
Humans
Infant
Intensive Care Units, Pediatric
Male
Patient Acceptance of Health Care
Patient Discharge
Quality of Life
Social Class
