• Cristin Q Fritz, Matt Hall, Jessica L Bettenhausen, Andrew F Beck, Molly K Krager, Katherine L Freundlich, Dena Ibrahim, Joanna E Thomson, James C Gay, Alison R Carroll, Maya Neeley, Patricia A Frost, Alison C Herndon, Allysa L Kehring, and Derek J Williams.
• Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
• J Hosp Med. 2022 Apr 1; 17 (4): 243251243-251.

BackgroundDisproportionately high acute care utilization among children with medical complexity (CMC) is influenced by patient-level social complexity.ObjectiveThe objective of this study was to determine associations between ZIP code-level opportunity and acute care utilization among CMC.Design, Setting, And ParticipantsThis cross-sectional, multicenter study used the Pediatric Health Information Systems database, identifying encounters between 2016-2019. CMC aged 28 days to <16 years with an initial emergency department (ED) encounter or inpatient/observation admission in 2016 were included in primary analyses.Main Outcome And MeasuresWe assessed associations between the nationally-normed, multi-dimensional, ZIP code-level Child Opportunity Index 2.0 (COI) (high COI = greater opportunity), and total utilization days (hospital bed-days + ED discharge encounters). Analyses were conducted using negative binomial generalized estimating equations, adjusting for age and distance from hospital and clustered by hospital. Secondary outcomes included intensive care unit (ICU) days and cost of care.ResultsA total of 23,197 CMC were included in primary analyses. In unadjusted analyses, utilization days decreased in a stepwise fashion from 47.1 (95% confidence interval: 45.5, 48.7) days in the lowest COI quintile to 38.6 (36.9, 40.4) days in the highest quintile (p < .001). The same trend was present across all outcome measures, though was not significant for ICU days. In adjusted analyses, patients from the lowest COI quintile utilized care at 1.22-times the rate of those from the highest COI quintile (1.17, 1.27).ConclusionsCMC from low opportunity ZIP codes utilize more acute care. They may benefit from hospital and community-based interventions aimed at equitably improving child health outcomes.© 2022 Society of Hospital Medicine.

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