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Identifying Pediatric Patients at High Risk for Adverse Events in the Hospital

PIPSQC is pleased to share the new publication in Hospital Pediatrics, entitled "Racial, ethnic, and socioeconomic disparities in patient safety events for hospitalized children." In this study, investigators used a pediatric global trigger tool to identify disparities in safety events for a large, random sample of pediatric patients across 16 hospitals. Latino children experienced nearly twice the rate of adverse events when compared with white children. Publicly insured children also had a higher adverse event rate.

The publication is available online at:
https://www.ncbi.nlm.nih.gov/pubmed/30509900

A related editorial is available online at:
http://hosppeds.aappublications.org/content/9/1/67

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.

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Identifying Pediatric Patients at High Risk for Adverse Events in the Hospital