Abstract
Background: Health inequity is an acknowledged clinical issue in pediatric cardiology with disparate outcomes for patients of difference races and ethic groups nationwide. Currently, there are no institutional real-time data dashboards to quantify local level inequities and target improvement projects. Goals Our aim was to determine metrics to measure patient outcomes and develop a health equity analysis tool to measure impact of future projects. Methods: This phase of the project was done in a three-step process. First, providers, administrators, and other stakeholders were surveyed to generate metric ideas. Next, PAC3 and PC4 Arbormetrix databases were utilized to note comparisons across institutions for these metrics. Finally, Lucile Packard Children's Hospital (LPCH) cardiac surgical data from 2017-2022 was used to determine metrics with statistical significance between groups of various demographic factors with standardization by procedure type, STAT category, and cardiopulmonary bypass time analysis. Results: Final metrics included postoperative length of stay (LOS), 30-day readmission rate, database discharge mortality, and hospital acquired complications. These were compared across race, ethnicity, Degauss scored socioeconomic status, and insurance type. For the most complex procedures (STAT category 5), LOS was nearly double for Hispanic vs. non-Hispanic patients (63 vs 34 days.) Additionally, Hispanic patients had a two-fold higher rate of 30-day readmission compared to non-Hispanic patients after pulmonary artery unifocalization surgery (8.0% vs. 4.0%) and 1.5-fold higher after VSD surgery (8.3% vs. 5.6%.) Conclusions: Utilizing these metrics, LPCH can efficiently note disparities in cardiac care and develop targeted solutions to mitigate them. Higher 30-day readmission rates, for example, may point to issues with health literacy or access. A final dashboard representing these metrics and analysis will be used by LCPH quality and improvement committees. Finally, further research and development will be done with partners at similar healthcare institutions regarding external validation and expansion.
Published Version
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