Racial, Ethnic, and Socioeconomic Disparities in Patient Safety Events for Hospitalized Children

Abstract

OBJECTIVES: Previous studies have revealed racial/ethnic and socioeconomic disparities in quality of care and patient safety. However, these disparities have not been examined in a pediatric inpatient environment by using a measure of clinically confirmed adverse events (AEs). In this study, we do so using the Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool. METHODS: GAPPS was applied to medical records of randomly selected pediatric patients discharged from 16 hospitals in the Pediatric Research in Inpatient Settings Network across 4 US regions from January 2007 to December 2012. Disparities in AEs for hospitalized children were identified on the basis of patient race/ethnicity (black, Latino, white, or other; N = 17 336 patient days) and insurance status (public, private, or self-pay/no insurance; N = 19 030 patient days). RESULTS: Compared with hospitalized non-Latino white children, hospitalized Latino children experienced higher rates of all AEs (Latino: 30.1 AEs per 1000 patient days versus white: 16.9 AEs per 1000 patient days; P ≤ .001), preventable AEs (Latino: 15.9 AEs per 1000 patient days versus white: 8.9 AEs per 1000 patient days; P = .002), and high-severity AEs (Latino: 12.6 AEs per 1000 patient days versus white: 7.7 AEs per 1000 patient days; P = .02). Compared with privately insured children, publicly insured children experienced higher rates of preventable AEs (public: 12.1 AEs per 1000 patient days versus private: 8.5 AEs per 1000 patient days; P = .02). No significant differences were observed among other groups. CONCLUSIONS: The GAPPS analysis revealed racial and/or ethnic and socioeconomic disparities in rates of AEs experienced by hospitalized children across a broad range of geographic and hospital settings. Further investigation may reveal underlying mechanisms of these disparities and could help hospitals reduce harm.

Medical adverse events in the US 2018 mortality data

“…A prospective cohort design with detailed data on sociodemographics, comorbidities and healthcare utilization throughout the life-course would have provided a more reliable basis for studying the predictors of adverse event mortality. For example, previous evidence has suggested that patients with low socioeconomic status have a higher risk of medical adverse events ( Burstin et al, 1992 , Stockwell et al, 2019 , Shen et al, 2016 ), but it is also likely that the cause-of-death distribution varies markedly by socioeconomic position, and adverse event deaths may be masked behind higher overall mortality. It would be difficult to reliably distinguish these phenomena from each other using the present dataset.…”

Choosing Wisely in Pediatric Hospital Medicine: 5 New Recommendations to Improve Value

“…[82][83][84] The risks of hospitalization are also likely disproportionately borne by Black and Latino children and children from families who possess limited English proficiency, who experience greater rates of adverse events during and after hospitalization. [85][86][87][88] In addition to safety, families undergo financial burden due to hospitalization, which extends beyond medical expenses. 89,90 Safely implementing these recommendations will necessitate engagement and coordination between hospitalists and community pediatricians to transition care back to the community sooner.…”

Implicit Bias and Caring for Diverse Populations: Pediatric Trainee Attitudes and Gaps in Training

“…1 Racial disparities in pediatric care have been found across the spectrum of subspecialities. [2][3][4][5][6][7][8][9][10][11][12][13] Pediatric disparities in care and evidence of clinician bias have been examined related to socioeconomic status, 14 language, 15 sexual orientation, 16 gender identity, 17 and weight. 18 The underlying causes of these disparities in care are often multifactorial, including structural, institutional, and individual factors.…”