Child Opportunity Index and 30-Day Readmission Among Children Discharged With New Long-Term Mechanical Ventilation via Tracheostomy: A Pediatric Health Information System Database Study, 2014-2023.

Abstract

Objectives: To examine the association between neighborhood-level social determinants of health (SDOH), as measured by the Child Opportunity Index (COI), and 30-day all-cause same-hospital readmission among children newly discharged on long-term mechanical ventilation via tracheostomy (LTMV-T).

Design: Multicenter, retrospective cohort study.

Setting: Forty-seven pediatric hospitals contributing data to the Pediatric Health Information System (PHIS) database.

Patients: Children of 0-18 years old with newly used LTMV-T between 2014 and 2023.

Interventions: None.

Measurements and main results: The COI is a composite measure of neighborhood-level SDOH, reported in quintiles (very low to very high opportunity). The primary outcome was 30-day all-cause same-hospital readmission, defined as the first observation or inpatient unit readmission to the index hospital where tracheostomy and ventilator initiation had occurred. Other clinical characteristics and demographic data were collected. Of the 5927 children identified in the PHIS database, 26% of children ( n = 1521) were readmitted within 30 days. Half of the cohort lived in very low- to low-opportunity neighborhoods. Multivariable mixed-effects models did not identify an association between 30-day readmission and living in lower compared with very high COI neighborhoods. Factors associated with lower odds (adjusted odds ratio [aOR; 95% CI]) of readmission were older age at discharge (e.g., ≥ 11 yr vs. < 6 mo; aOR, 0.64 [95% CI, 0.49-0.84]) and discharge to other health care facilities (vs. home discharge aOR, 0.64 [95% CI, 0.54-0.76]). Regarding length of stay, there was a 3% greater odds of readmission for every additional 30 days (aOR, 1.03 [95% CI, 1.01-1.04]).

Conclusions: The PHIS database (2014-2023) shows that around one-in-four admissions discharged with new LTMV-T were readmitted within 30 days. However, we failed to identify an association between residence in lower compared with very high COI neighborhoods and 30-day readmission. Given the early readmission burden, future efforts should prioritize interventions to reduce hospital returns.