Hospitalized minority kids were getting less attentive care
Hospitalized minority children were developing serious bloodstream infections at a higher rate than similar white children in a prominent Seattle hospital, likely due to less attentive care, researchers found in a study that helped correct the issue.
In some units at Seattle Children's Hospital, the staff were not monitoring catheters in minority children as often as in white children, leading to more infections, researchers there reported in JAMA Pediatrics. The rates evened out after researchers realized the minority children were getting substandard care.
To determine whether disparities in first central catheter–associated bloodstream infection (CLABSI) rates existed for pediatric patients of minoritized racial, ethnic, and language groups and to evaluate the outcomes associated with quality improvement initiatives for addressing these disparities. This cohort study retrospectively examined outcomes of 8269 hospitalized patients with central catheters from October 1, 2012, to September 30, 2019, at a freestanding quaternary care children’s hospital. Subsequent quality improvement interventions and follow-up were studied, excluding catheter days occurring after the outcome and episodes with catheters of indeterminate age through September 2022. Central catheter–associated bloodstream infection events identified by infection prevention surveillance according to National Healthcare Safety Network criteria were reported as events per 1000 central catheter days. Cox proportional hazards regression was used to analyze patient and central catheter characteristics, and interrupted time series was used to analyze quality improvement outcomes.
The separate recent study Journal of the American Heart Association found yet another example of racial disparities in healthcare: low-income minority adults with diabetes and heart failure are less likely to get appropriate care after hospital discharge.
Ambulatory follow‐up for all patients with heart failure (HF) is recommended within 7 to 14 days after hospital discharge to improve HF outcomes. They examined postdischarge ambulatory follow‐up of patients with comorbid diabetes and HF from a low‐income population in primary and specialty care.
Adults with diabetes and first hospitalizations for HF, covered by Alabama Medicaid in 2010 to 2019, were included and the claims analyzed for ambulatory care use (any, primary care, cardiology, or endocrinology) within 60 days after discharge using restricted mean survival time regression and negative binomial regression. Among 9859 Medicaid‐covered adults with diabetes and first hospitalization for HF (mean age, 53.7 years; SD, 9.2 years; 47.3% Black; 41.8% non‐Hispanic White; 10.9% Hispanic/Other [Other included non‐White Hispanic, American Indian, Pacific Islander and Asian adults]; 65.4% women, 34.6% men), 26.7% had an ambulatory visit within 0 to 7 days, 15.2% within 8 to 14 days, 31.3% within 15 to 60 days, and 26.8% had no visit; 71% saw a primary care physician and 12% a cardiology physician. More than half of Medicaid‐covered adults with diabetes and HF in Alabama did not receive guideline‐concordant postdischarge care. Black and Hispanic/Other adults were less likely to receive recommended postdischarge care for comorbid diabetes and HF.
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