Socioeconomic deprivation linked to missed pediatric complex care center visits

Researchers found a significant association between neighborhood socioeconomic depression and missed clinic visits for children with medical complexity, according to a study published in Pediatrics.

In a video that accompanied the study online, Joanna Thomson, MD, MPH, attending physician in the division of hospital medicine at Cincinnati Children’s, said the research was meant to address how little was known about how neighborhood context influences the health of children with medical complexity, and specifically the medical complexity of chronic multisystem diseases, “resulting in frequent health care utilization and functional limitations, including technology dependence.”

“Neighborhood characteristics, including socioeconomic context, can provide insight to patient- and population-level risks and assets that influence these conditions of daily life have been linked to health outcomes for multiple pediatric conditions,” Thomson said. “We know that these children and their families experience immense clinical challenges and the corresponding strains on family life, but less is known about how the socioeconomic context in which they live influences the challenges they face.”

Thomson and colleagues conducted a cross-sectional study that examined 512 children with medical complexities receiving care at the Cincinnati Children’s Complex Care Center, a medical home for medically complex children, between 2016 and 2018.

Each patient’s neighborhood-level deprivation index was considered — a measure that includes six U.S. Census variables, including percentages of households below the federal poverty level, of adults with less than a high school education, population without health insurance, households receiving public assistance, vacant housing units in the area and median household income. The researchers also noted the patients’ ED visits, hospitalizations, inpatient bed days at the center and missed appointments.

Although there was no noted association between area-level department visits (adjusted RR = 0.98; 95% CI, 0.93-1.04), hospitalizations (aRR = 0.97; 95% CI, 0.92-1.01), or inpatient bed days (aRR = 1; 95% CI, 0.8-1.27), the researchers did notice a 13% relative increase in the missed clinic visit rate for every 0.1 unit increase in the Deprivation Index (95% CI, 8%-18%).

“Neighborhood socioeconomic context was associated with adherence to patient-centered medical home assets,” Thomson said. “We believe that understanding the context and barriers to care arising from the socioeconomic context of medical complexity is critical to ensuring equitable care and outcomes for this population.”