Links between childhood asthma and socioeconomic disparities have been well-established through previous studies; poor, minority and urban children are said to be at the highest risk for emergency care and hospital admission for asthma. But Cincinnati Children’s researchers say that clinical care guidelines are designed to provide standardized care to all child asthma sufferers.
“Most children receive the same inpatient care despite differences in socioeconomic risk for poorer outcomes,” said Dr. Andrew Beck, M.D., pediatrician at Cincinnati Children’s Hospital Medical Center and lead author of the study.
But that may all change thanks to the new study, published in the American Journal of Public Health. Just by knowing a child’s home address, physicians and hospitals may soon be able to access census-based information on poverty, home values and the number of adults in the area with high school diplomas. Study authors say that hospitals may be able to use this information to predict which pediatric asthma patients are at the highest risk of returning for future admittance or emergency room visits.
Study authors also say the “geographical social risk index” can help them identify families that are most likely to report financial or psychological hardship. Beck says both factors been linked to an increased risk of adverse asthma outcomes in children.
“Early identification of children at increased risk could allow additional assessments and services to be put in place prior to discharge to improve patient outcomes. It could also help to target and use scarce and overburdened hospital and community resources more efficiently,” said Dr. Beck, adding that ““The use of this data to help identify children admitted to the hospital with asthma who may need more aggressive, targeted assessments and/or interventions may prevent asthma attacks and reduce disparities.”
“These interventions could include enhanced care coordination, community health workers or help with better housing,” added Robert Kahn, M.D. senior investigator of the study. “The index could work like an extra vital sign at admission, increasing our ability to know a child’s likelihood of returning to the hospital. This would allow you to trigger an enhanced clinical care pathway right at the start of admission. Reducing such re-admissions is increasingly critical in the era of healthcare reform.”
To arrive at their conclusion, researchers geocoded home addresses (grouping households together by geographical area) in their area and constructed their social risk index from assigned census tract regions. Data included information on high school graduation rates, median home values and extreme poverty rates. Researchers then evaluated 601 children hospitalized for asthma and placed them in one of three risk categories: low, medium and high.
Overall, researchers determined that 39 percent of all patients returned to the hospital within 12 months; some were readmitted while others were simply emergency room visits. When comparing children in the low-risk group to the children in the high-risk group, it was determined that children in the high risk category were 80 percent more likely to revisit the hospital. Researchers also determined that caregivers of high-risk children were five times more likely to report two or more financial hardships and three times more likely to report psychological distress than children in the low-risk category. Children in the medium-risk category were 30 percent likely to return to the hospital than children in the low-risk group.
While the information on pediatric asthma patients may not be used immediately, researchers are already looking to try and use the geographical social risk index to study other asthma outcomes along with other health conditions, like diabetes. They say the overall idea is to try and determine if geographical data can help lead to more reliable, in-depth triage for patients. However, they would also like to evaluate whether or not the information will help link hospital and community-based care to patients who are most likely to need and benefit from it.
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