When a child’s health leads to frequent visits to the emergency room or hospital admissions, the whole family is affected. Children miss school, parents miss work and potentially lose wages, and siblings experience disruptions in caregiving. These readmission rates and revisits to the emergency room also represent a substantial expense to the health care system. We know that certain social determinants of health, such as income and air quality, impact likelihood of readmission, but that relationship has been difficult to measure, given the complexities of those factors.
Health Equity Applications for the COI
New research uses the Child Opportunity Index to examine the relationship between neighborhood opportunity and revisits to the emergency room and hospital. Because the COI fully captures the multidimensional social determinants of health that describe inequitable distribution of opportunity across households, it is a better tool to use than a single measure, such as income.
The study, published in Academic Pediatrics and co-authored by Jessica L. Bettenhause, Clemens Noelke, Robert W. Ressler, Matthew Hall and others, looked at over 96,000 unplanned 30-day readmissions and emergency room revisits at pediatric hospitals nationwide. It found that these return visits were more common among children in low opportunity neighborhoods, even after adjusting for important clinical and demographic factors.
Takeaways for Policy
The research indicates the usefulness of the COI for hospitals and care networks seeking to define and address inequities that affect health outcomes at the community level, as opposed to the individual level. It also demonstrates that including the COI in analyses of hospital readmissions could prevent hospitals that serve predominantly low-opportunity neighborhoods from being unfairly penalized by insurers for having high readmission rates.