Trends in Health Care Use and Spending for Young Children With Neurologic Impairment

Bayer, Nathaniel D.; Hall, Matthew; Li, Yue; Feinstein, James A.; Thomson, Joanna; Berry, Jay G.

doi:10.1542/peds.2021-050905

Cited by 6 publications

(6 citation statements)

References 43 publications

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“…One possibility is that patients with neurologic impairment may not undergo as many pulmonary CTs if clinicians feel the trajectory of their illness may not change. 47 However, our multivariable analysis suggests that enteral tube status confers additional risk in neurologic patients even when controlling for aspiration. Some clinicians advocate for enteral tube placement and avoidance of oral feeding in neurologic patients with concern for poor airway protection; however, our findings suggest universal implementation of this approach may not be beneficial.…”

Section: Discussionmentioning

confidence: 73%

“…It is notable that neurologic comorbidity was associated with lower risk in our cohort but the potential mechanism for this finding is unknown. One possibility is that patients with neurologic impairment may not undergo as many pulmonary CTs if clinicians feel the trajectory of their illness may not change 47 . However, our multivariable analysis suggests that enteral tube status confers additional risk in neurologic patients even when controlling for aspiration.…”

Section: Discussionmentioning

confidence: 89%

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Gastrointestinal factors associated with risk of bronchiectasis in children

Duncan

Cohen

Golden

et al. 2022

Pediatric Pulmonology

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Objective To evaluate gastrointestinal (GI) risk factors for bronchiectasis in children. We hypothesized that upper GI tract dysmotility would be associated with increased risk of bronchiectasis. Study design Subjects in this retrospective cohort study included those evaluated for persistent pulmonary symptoms in the Aerodigestive Center at Boston Children's Hospital who underwent chest computed tomography (CT) between 2002 and 2019. To determine gastrointestinal predictors of bronchiectasis, baseline characteristics, comorbidities, enteral tube status, medications received, gastroesophageal reflux burden, adequacy of swallow function, esophageal dysmotility, gastric dysmotility, and neutrophil count on bronchoalveolar lavage (BAL) were compared between patients with and without bronchiectasis. Proportions were compared with Fisher's exact test and binary logistic regression with stepwise selection was used for multivariate analysis. ROC analyses were utilized to compare BAL neutrophils and bronchiectasis. Results Of 192 subjects, 24% were found to have evidence of bronchiectasis on chest CT at age 7.9 ± 0.5 years. Enteral tubes (OR 5.77, 95% CI 2.25–14.83, p < 0.001) and increased BAL neutrophil count (OR 5.79, 95% CI 1.87–17.94, p = 0.002) were associated with increased risk while neurologic comorbidities were associated with decreased risk (OR 0.24, 95% CI 0.09–0.66, p = 0.006). Gastroesophageal reflux was not found to be a significant risk factor. Neutrophil counts >10% had 72% sensitivity and 60% specificity for identifying bronchiectasis. Conclusions Enteral tubes were associated with significantly increased risk of bronchiectasis but gastroesophageal reflux was not. Providers should consider obtaining chest CT to evaluate for bronchiectasis in children found to have unexplained elevated BAL neutrophil count.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 89%

Gastrointestinal factors associated with risk of bronchiectasis in children

Duncan

Cohen

Golden

et al. 2022

Pediatric Pulmonology

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“…Infants <1 year of age were excluded, given marked differences in hospital utilization in the first year of life for this population. 15 Children transferred from referring hospitals were also excluded.…”

Section: Methodsmentioning

confidence: 99%

“… 2 To capture a population of children with neurological diagnoses resulting in significant functional impairments, we excluded children with epilepsy as their only NI diagnosis as these children often do not have associated functional impairments. Infants <1 year of age were excluded, given marked differences in hospital utilization in the first year of life for this population 15 . Children transferred from referring hospitals were also excluded.…”

Section: Methodsmentioning

confidence: 99%

Impact of the COVID‐19 pandemic on hospitalizations of children with neurologic impairment

Thomson

Richardson

Auger

et al. 2022

Journal of Hospital Medicine

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Introduction: Children with neurologic impairment (NI) are frequently hospitalized for infectious and noninfectious illnesses. The early period of the COVID-19 pandemic was associated with overall lower pediatric hospitalization rates, particularly for respiratory infections, but the effect on utilization for children with NI is unknown. Method: This multicenter retrospective cohort study included hospitalizations of children 1-18 years of age with NI diagnosis codes from 49 children's hospitals. We calculated the percent change in the median weekly hospitalization volumes and the hospitalization resource intensity score (H-RISK), comparing the early-COVID era (March 15, 2020 to December 31, 2020) with the pre-COVID era (same timeframe of 2017-2019). Percent change was calculated over the entire study period as well as within three seasonal time periods (spring, summer, and fall/winter). Differences between infectious and noninfectious admission diagnoses were also examined.Results: Compared with the pre-COVID era, there was a 14.4% decrease (interquartile range [IQR]: −33.8, −11.7) in the weekly median number of hospitalizations in the early-COVID era; the weekly median H-RISK score was 11.7% greater (IQR: 8.9, 14.9). Hospitalizations decreased for both noninfectious (−11.6%, IQR: −30.0, −8.0) and infectious (−35.5%, IQR: −51.1, −31.3) illnesses in the early-COVID era. This decrease was the largest in spring 2020 and continued throughout 2020.Conclusions: For children with NI, there was a substantial and significant decrease in hospitalizations for infectious and noninfectious diagnoses but an increase in illness severity during the early-COVID era compared with the pre-COVID era. Our data suggest a need to reconsider current thresholds for hospitalization and identify opportunities to support and guide families through certain illnesses without hospitalization.

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“…Cutting-edge technology needs, therefore, to play an increasingly significant role in our healthcare system. Many insurance companies are investing in the adoption of proactive approaches to detect health issues early and avoid hospitalizations [ 5 , 6 ]. One way to reduce hospitalizations and improve healthcare is to move from constant monitoring in health facilities to remote patient monitoring.…”

Section: Introductionmentioning

confidence: 99%

Unlocking Insights in IoT-Based Patient Monitoring: Methods for Encompassing Large-Data Challenges

Waleed,

Kamal,

et al. 2023

Sensors

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The remote monitoring of patients using the internet of things (IoT) is essential for ensuring continuous observation, improving healthcare, and decreasing the associated costs (i.e., reducing hospital admissions and emergency visits). There has been much emphasis on developing methods and approaches for remote patient monitoring using IoT. Most existing frameworks cover parts or sub-parts of the overall system but fail to provide a detailed and well-integrated model that covers different layers. The leverage of remote monitoring tools and their coupling with health services requires an architecture that handles data flow and enables significant interventions. This paper proposes a cloud-based patient monitoring model that enables IoT-generated data collection, storage, processing, and visualization. The system has three main parts: sensing (IoT-enabled data collection), network (processing functions and storage), and application (interface for health workers and caretakers). In order to handle the large IoT data, the sensing module employs filtering and variable sampling. This pre-processing helps reduce the data received from IoT devices and enables the observation of four times more patients compared to not using edge processing. We also discuss the flow of data and processing, thus enabling the deployment of data visualization services and intelligent applications.

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Trends in Health Care Use and Spending for Young Children With Neurologic Impairment

Cited by 6 publications

References 43 publications

Gastrointestinal factors associated with risk of bronchiectasis in children

Gastrointestinal factors associated with risk of bronchiectasis in children

Impact of the COVID‐19 pandemic on hospitalizations of children with neurologic impairment

Unlocking Insights in IoT-Based Patient Monitoring: Methods for Encompassing Large-Data Challenges

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