20 Differential performance of pediatric key performance indicators by health equity factors

Background

Growing literature shows that a number of social factors can be predictors of health outcomes – with influence on health issues such as infant mortality, surgical outcome, and wait times for kidney transplantation.

Objectives

We evaluated the influence of multiple social factors on performance on multiple key performance indicators (KPIs) tracked at our pediatric healthcare system.

Methods

We compared performance for rates on the following KPIs for a 2-year period (2019, 2020) – Serious Safety Events (SSE), Central Line Associated Blood Stream Infection (CLABSI), Hospital-Acquired Pressure Injury (HAPI), Codes Outside ICU, and Influenza Non-vaccination. We evaluated differential performance on those rates by the following factors that might affect health equity - patient gender, language preference, health insurance payer category, race and ethnicity, and estimated median household income based on zip code analysis - by creating simultaneous 95% confidence intervals using the Wilson method with continuity correction and a Bonferroni adjustment for the number of categories compared.

Results

Children who resided in an area with a lower median household income had a statistically significant greater chance to develop HAPI (figure 1). A similar but not statistically significant trend was also seen with CLABSI. The SSE rate was 2.3 times higher in Spanish-speaking as compared to English-speaking children and 2.2 times higher for Medicaid as compared to commercially ensured patients (not statistically significant). Statistically significant differences in influenza non-vaccination rate were present for the following indicators: Spanish and Chinese Dialects > than English speaking; Hispanic > many other race and ethnicities; Commercial < Public or Self-pay; and lower < higher median household income.

Conclusions

Factors influencing health equity correlated with decreased performance on a number of our health system KPIs. This quality and safety issue will benefit from improvement initiatives that seek to better understand and decrease the influence of these factors.