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Abstract
Background The Child Opportunity Index (COI) is a multidimensional measure of US neighbourhood-level conditions needed for healthy development. COI is associated with healthcare delivery and outcomes. Formal quality improvement (QI) may influence the relationship between COI, quality of care and outcomes in children.
Objective To assess the association between COI and paediatric sepsis care delivery and outcomes and determine if baseline disparities in care change over time among hospitals in the Improving Pediatric Sepsis Outcomes (IPSO) collaborative.
Methods Retrospective cohort study of IPSO patients probabilistically linked to the Pediatric Health Information System database from 2017 to 2021. Primary exposure was COI. We estimated differences in the proportions of patients in each COI quintile identified via standardised sepsis recognition protocols (screening tool, huddle documentation and/or order set use) and who received a bundle of recommended care (standardised sepsis recognition, plus bolus <1 hour and antibiotic <3 hours). We further assessed the timeliness of each bundle component and mortality. We evaluated changes in standardised sepsis recognition over time using generalised linear models.
Results 31 260 sepsis cases from 24 hospitals were included. Cross-sectional analysis over the entire study period found patients in the Very High COI quintile were most likely to be identified via standardised recognition protocols and receive IPSO’s recommended care bundle (67.7% and 46%, respectively). Over time, standardised sepsis recognition improved for all; the greatest improvements were among inpatients in the Very Low COI quintile.
Conclusion Disparities exist in paediatric sepsis care delivery by COI. Over the course of the IPSO collaborative, care improved most for children in the lowest COI quintile. QI collaboratives focused on standardisation and shared learning may reduce disparities.
- Paediatrics
- Collaborative, breakthrough groups
- Healthcare quality improvement
- Trigger tools
Data availability statement
No data are available.
Data availability statement
No data are available.
Footnotes
X @JeffAuletta, @okpedscns, @JLockwoodMD, @Jen_WilkesMD
Correction notice This article ahs been corrected since it was first published online. The author Sarah Kandil was incorrectly listed as Sarah Kandi.
Collaborators IPSO Collaborative Investigators: Ahmed Arshad (ahmed.arshad@ouhealth.com), Kristina Betters (kristina.betters@vumc.org), Katharine Boyle (katie.boyle@vumc.org), Emily Dawson (emily.dawson@aah.org), Kimberly Denicolo (kdenicolo@luriechildrens.org), Jaime Fox (jfox@childrenswi.org), Sherry Johnson (Sherry.Johnson@STJUDE.ORG), Carter Kasetani (Carter.Kasetani@childrenscolorado.org), Grant Keeney (gkeeney@multicare.org), Roni Lane (roni.lane@hsc.utah.edu), Stephanie Lavin (stephanie.lavin@cookchildrens.org), Melissa Magill (MagillM@archildrens.edu), Pamela Nelly (pnelly@akronchildrens.org), Megan O’Connell (moconnell@luriechildrens.org), Jolene Palmer (jmpalmer@cmh.edu), Janette Parks (Janette.parks@seattlechildrens.org), Sanjiv Pasala (SPasala@uams.edu), Kelly Perez (kelly.perez@aah.org), Jay Rillinger (jfrilinger@cmh.edu), Jennifer Rizzi (jennifer.rizzi@memorialhermann.org), Jillian Rojas (jrojas@luriechildrens.org), Ranna Rozenfeld (ranna_rozenfeld@brown.edu), Matthew Sharron (MSharron@childrensnational.org), Jonathan Silverman (jonathan.silverman@vcuhealth.org), Brittany Slagle (BSlagle@uams.edu), Elizabeth (Lisa) Smith (ESmith2@akronchildrens.org), Rebecca Stephen (rstephen@luriechildrens.org), Kathryn Stephens (kathryn.stephens@memorialhermann.org), Hannah Stinson (stinsonh@chop.edu), Viktoriya Stoycheva (vgstoycheva@cmh.edu), Michael Stroud (StroudMichaelH@uams.edu), Corrie Tarbert (ctarbert@umm.edu), Nathan Thompson (nathomps@mcw.edu)
Contributors LR, TR, JA, FB, AC, JF, JG, KAG, AG, VG, HH, LH, SK, GL, JL, KL, EM, KM, MN, RP, AR, RR, JR, MS, HS, JW, MAE and CI contributed to the initial concept and study design. TR and RR collected and analysed the data. LR, MAE and TR drafted the initial manuscript. Authors JA, FB, AC, JF, JG, KAG, AG, VG, HH, LH, SK, GL, JL, KL, EM, KM, MN, RP, AR, RR, JR, MS, HS, JW and CI critically reviewed and revised the manuscript for important intellectual content. All authors reviewed and approved the final version of the manuscript for submission. LR is responsible for the overall content as guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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