249 - Associations Between Income and Readmission Rate Among Children with Medical Complexity

Poster Number: 249
Publication Number: 249.1513

Background: Children with Medical Complexity (CMC) are defined as children who have one or more Complex Chronic Condition (CCC) lasting for 12 months or more, and who need specialty care, use assistive technology, and have high use of healthcare resources including hospital admissions. Caregivers of CMC are more likely to experience poverty. Poverty is associated with acute health care use for children with chronic illness, and CMC might be at most risk. There is limited research examining the relationship between income and hospital readmissions for CMC.

Objective: To evaluate the association between household income and rate of readmission among CMC and to assess the difference by level of child medical complexity

Design/Methods: This was a cross-sectional study which reviewed unplanned pediatric 30-day readmissions at six tertiary care centers over five years. CMC were identified via chart review, and were defined as those with multiple complex chronic conditions and use of technology assistance. Phone interviews were conducted to survey parents of CMC for social determinants of health including income, access to healthcare, and parent level of education. Independent variable was household income quartile. Dependent variable was 30-day readmission rate. Negative binomial regression models were used to measure the incidence rate ratio for the association between income level and rate of readmission, adjusting for child age and distance from medical facility. There was evidence for interaction between income and complexity level, we stratified models by level of medical complexity.

Results: 292 of 680 parents of CMC with 30-day readmissions were surveyed. Household income showed a significant inverse association with readmission rate, where children from families on social security benefits (lowest income) had the highest incidence rate of readmission compared to children from families with monthly income ≥10,000 SR (~2,666 US$) (table 3). This relationship was stronger for children with moderate complexity (CMC with 3 CCC) compared to those with severe complexity (CMC with 4 or more CCC).

Conclusion(s): The findings suggest that lower family income is associated with a higher readmission rate among children with medical complexity, independent of age and distance to medical care facilities; complexity level modifies this association. Interaction by level of complexity suggests that there may be different drivers of this association depending on level of complexity, suggesting opportunities for future clinical and policy interventions.