- A new Health Affairs study finds "pervasive" disparities in pediatric inpatient stays between children from poorer communities and those from affluent neighborhoods.
- The researchers looked at pediatric hospitalizations for all causes across Hamilton County, Ohio, and calculated bed-day rates according to census tract. Each census tract was subsequently divided into quintiles based on child poverty rates and bed rates.
- The all-cause inpatient bed-day rate for low poverty districts was 13.4% versus 20% for medium poverty and 21.9% for high medium poverty districts. In particular, “hot spots” of poverty had bed-day rates more than twice the country average, at 27.2%.
The study suggests that hospitals should spend more time on inpatient to outpatient transitions and on population health. Specifically, it calls for a robust culture of health both within hospitals and in collaboration with the broader community to change this dynamic.
“If children from all of Hamilton County’s census tracts spent the same amount of time in the hospital as those from the most affluent tracts, roughly twenty-two child-years of hospitalization time would be prevented annually,” the authors wrote. “Disparities such as this can be reduced, in part, by a strengthened culture of health within a hospital or health care system whose goals are aligned with those of the community it supports.”
With the shift to value-based payment models, hospitals and health systems are incentivized to reduce inpatient stays and treat more patients in alternative care delivery settings. Key to improving utilization is “ensuring that health equity is made a ‘shared value’” within organizations, the authors said. That means ensuring information on condition and subspecialty-related disparities reaches front-line physicians.
While the study looked at a narrow population, its findings echo others on health equity.
For example, a recent study in the Annals of Internal Medicine found that the Value-Based Modifier (VM) program had little impact on performance measures and could increase health disparities without improving performance if risk-adjustment formulas and incentives are inadequate. Another study published in Health Affairs argued a health-in-all-policies approach can raise awareness of health disparities, but doesn’t necessarily lead to broad policy reforms or improvements in overall health equity.
To address the problem, the National Quality Forum issued a roadmap demonstrating how performance measures and related policies can reduce disparities and ensure more equitable care across races, ethnicities and income groups. The roadmap focuses on four components of care: identifying and prioritizing disparities; implementing evidence-based interventions, investing in health equity performance measures; and rewarding efforts to close the equity gap.