Child Health Care Utilization Research Articles

Geographic differences in maternal and child health care utilization in four Ethiopian regions; a cross-sectional study

BackgroundMaternal and child health (MCH) care utilization often vary with geographic location. We analyzed the geographic distribution and determinants of utilization of four or more antenatal care visits, health facility delivery, child immunization, and care utilization for common childhood illnesses across four Ethiopian regions.MethodsA cross-sectional community-based study was employed with two-staged stratified cluster sampling in 46 districts of Ethiopia. A total of 6321 women (13–49 years) and 3110 children below the age of 5 years residing in 5714 households were included. We performed a cluster analysis of the selected MCH care utilization using spatial autocorrelation. We identified district-specific relationships between care coverage and selected factors using geocoded district-level data and ordinary least squares and hotspot analysis using Getis Ord Gi*.ResultsOf the 6321women included in the study, 714 had a live birth in the 12 months before the survey. One-third of the women (30, 95% CI 26–34) had made four or more antenatal visits and almost half of the women (47, 95% CI 43–51) had delivered their most recent child at a health facility. Nearly half of the children (48, 95% CI 40–57) with common childhood illnesses (suspected pneumonia, diarrhoea, or fever) sought care at the health facilities. The proportion of fully immunized children was 41% (95%, CI 37–45). Institutional delivery was clustered at district level (spatial autocorrelation, Moron’s I = 0.217, P < 0.01). Full immunization coverage was also spatially clustered (Moron’s I = 0.156, P-value < 0.1). Four or more antenatal visits were associated with women’s age and parity, while the clustering of institutional delivery was associated with the number of antenatal care visits. Clustering of full immunization was associated with household members owning a mobile phone.ConclusionsThis study showed evidence for geographic clustering in coverage of health facility deliveries and immunization at the district level, but not in the utilization of antenatal care and utilization of health services for common childhood illnesses. Identifying and improving district-level factors that influenced these outcomes may inform efforts to achieve geographical equitability and universal health coverage.

Health Care Utilization for Children in Foster Care.

To utilize hospital EMR data for children placed in foster care (FC) and a matched control group to compare: 1) health care utilization rates for primary care, subspecialty care, emergency department (ED) visits, and hospitalizations; 2) overall charges per patient-year; and 3) prevalence of complex chronic conditions (CCC) and their effect on utilization. Children ≤18 years old with a designation of FC placement and controls matched on age, race/ethnicity, gender, and zip code who had an encounter at an urban pediatric health system between 7/1/11 and 6/30/12 were identified in the EMR. Data on outpatient, ED, and inpatient encounters and charges for 7/1/12 to 6/30/13 were obtained. A general linear mixed-effects model was applied to estimate means and rates for each group. Analyses were repeated among the subpopulations of children with and without CCCs. A total of 1156 FC cases were matched to 4062 controls (mean = 3.5 controls/case). FC cases had significantly higher rates (per 100 patient-years) of hospitalizations (18.5 vs 12.7, P = .005), and subspecialty visits (173.3 vs 113.6; P < .001) but not ED (50.4 vs 45.2, P = .056) or primary care visits (154.6 vs 149.8; P = .50). FC cases had higher charges ($14,372 vs $7082; P < .001). Among children with CCCs, health care utilization rates and charges were higher among FC cases (all P < .001). Among children without CCC, rates and charges were similar for FC cases and controls (all P > .20). FC children utilized more hospitalizations and subspecialty office visits. The increased utilization rates and charges among children in FC were driven by the subset of children with CCCs.

The effect of a coaching program on asthma control and health care utilization in children with asthma

ABSRACTObjective: Poor adherence to asthma therapy is a major problem in the management of asthma. We aimed to assess if a designed coaching program in children with asthma, coming from low socioeconomic background, will reduce respiratory morbidity and health care utilization.Methods: A prospective interventional pilot study enrolling children aged 3–18 years, admitted to Soroka University Medical Center (SUMC) between October 2015 and May 2016 due to asthma exacerbation. The intervention group was part of a coaching program, which was conducted by medical and paramedical personnel and included a diagnostic and personal educational office visit and a house visit by a nurse educator for asthma. The control group comprised of demographically matched children with asthma, who were admitted to the SUMC, but did not go through any intervention. Medications purchase and health care utilization were extracted from the participants' HMO databases, during 1-year of follow-up.Results: 41 children were enrolled to the intervention group, with 63 children as a control group. No differences were found in asthma-related drugs purchase, number of clinic visits, ER admissions and hospitalizations during the follow-up year, although the intervention group showed a trend towards having a shorter length of stay (2.3 vs. 4.5 days, Cohen's D = 0.44, p = 0.06). The intervention group demonstrated subjective improvement in asthma control, as reflected in Asthma Control Test questionnaires.Conclusions: In this pilot study of coaching program for children with asthma coming from low income families, no decrease in health care utilization was shown. Larger and longer intervention programs are needed.

Association of Food Insecurity and Acute Health Care Utilization in Children With End-stage Kidney Disease

This study assesses food insecurity and acute health care utilization among pediatric patients with end-stage kidney disease undergoing peritoneal dialysis or hemodialysis.

Outpatient Healthcare Access and Utilization for Neonatal Abstinence Syndrome Children: A Systematic Review

Abstract Objective: The objective of this study was to systematically assess the literature regarding postnatal healthcare utilization and barriers/facilitators of healthcare in neonatal abstinence syndrome (NAS) children. Methods: A systematic search was performed in PubMed, Cochrane Database of Systematic Reviews, PsychINFO, CINAHL, and Web of Science to identify peer-reviewed research. Eligible studies were peer-reviewed articles reporting on broad aspects of primary and specialty healthcare utilization and access in NAS children. Three investigators independently reviewed all articles and extracted data. Study bias was assessed using the Newcastle-Ottawa Assessment Scale and the National Institute of Health Study Quality Assessment Tool. Results: This review identified 14 articles that met criteria. NAS children have poorer outpatient appointment adherence and have a higher rate of being lost to follow-up. These children have overall poorer health indicated by a significantly higher risk of ER visits, hospital readmission, and early childhood mortality compared with non-NAS infants. Intensive multidisciplinary support provided through outpatient weaning programs facilitate healthcare utilization and could serve as a model that could be applied to other healthcare fields to improve the health among this population. Conclusions: This review investigated the difficulties in accessing outpatient care as well as the utilization of such care for neonatal abstinence syndrome infants. NAS infants tend to have decreased access to, and utilization of outpatient healthcare following hospital birth discharge. Outpatient weaning programs have proven to be effective; however, these programs require intensive resources and care coordination that has yet to be implemented into other healthcare areas for NAS children.

Outpatient healthcare access and utilization for neonatal abstinence syndrome children: A systematic review.

The objective of this study was to systematically assess the literature regarding postnatal healthcare utilization and barriers/facilitators of healthcare in neonatal abstinence syndrome (NAS) children. A systematic search was performed in PubMed, Cochrane Database of Systematic Reviews, PsychINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science to identify peer-reviewed research. Eligible studies were peer-reviewed articles reporting on broad aspects of primary and specialty healthcare utilization and access in NAS children. Three investigators independently reviewed all articles and extracted data. Study bias was assessed using the Newcastle-Ottawa Assessment Scale and the National Institute of Health Study Quality Assessment Tool. This review identified 14 articles that met criteria. NAS children have poorer outpatient appointment adherence and have a higher rate of being lost to follow-up. These children have overall poorer health indicated by a significantly higher risk of ER visits, hospital readmission, and early childhood mortality compared with non-NAS infants. Intensive multidisciplinary support provided through outpatient weaning programs facilitates healthcare utilization and could serve as a model that could be applied to other healthcare fields to improve the health among this population. This review investigated the difficulties in accessing outpatient care as well as the utilization of such care for NAS infants. NAS infants tend to have decreased access to and utilization of outpatient healthcare following hospital birth discharge. Outpatient weaning programs have proven to be effective; however, these programs require intensive resources and care coordination that has yet to be implemented into other healthcare areas for NAS children.

Meds to Beds: A Quality Improvement Initiative to Increase Filling of Antimicrobial Prescriptions Prior to Discharge

Background: Poor medication compliance correlates with increased health care utilization in children. Delivery of medications to the bedside prior to discharge allows opportunities for patients to ask medication-related questions, avoidance of potential dosing or compounding issues at community pharmacies, identification of financial barriers, and eliminates an additional task to be performed after discharge. This study aims to increase the percentage of patients discharged from the Pediatric Hospital Medicine (PHM) service with an antimicrobial prescription who fill the prescription prior to discharge from 11.3% to 80% by October 2018. Methods: We assembled a multidisciplinary team comprised of pharmacists, nurses, social workers, care managers, electronic medical record (EMR) analysts, …

Respiratory Tract Infection Related Healthcare Utilisation in United Kingdom Children with Down's Syndrome

Purpose: Children with respiratory tract infections (RTIs) present often to General Practitioners (GP) services in the United Kingdom. For most children, RTIs are a mild and relatively short viral illness. However, in some 'at-risk' children such as those with Down's Syndrome (DS), RTIs can quickly become more serious and result in hospital admissions. This retrospective cohort study aims to quantify RTI-related healthcare utilisation in children with DS and controls to assess the risk of RTI-related hospitalisation, time to RTI-related hospitalisation, and re-consultation with their GP. Methods: We utilised …

Inpatient Health Care Utilization in Children With Hemophilia Before and After the Joint Outcome Study Publication

The "Joint Outcomes Study" (JOS) demonstrated improved joint outcomes for patients receiving primary prophylaxis versus on-demand therapy. The impact of primary prophylaxis on inpatient health care utilization is not well-defined. To evaluate changes in hospitalization care of children with hemophilia before and after the 2007 JOS publication, this study utilized the Pediatric Health Information System (PHIS) to evaluate admissions for patients with hemophilia A or B (age, 2 to 7) admitted between January 2002 and 2006 (pre-JOS) and January 2010 and 2014 (post-JOS). Discharge diagnosis codes and clinical transaction classifications were used to differentiate bleeding episodes, infections, bypass agent use, length of stay, and intensive care unit (ICU) management. Overall, admissions for bleeding episodes did not change (26.5% of admissions pre-JOS vs. 23.6% post-JOS, P=0.10). However, admissions for suspected infections increased (3.0% of admissions pre-JOS vs. 7.2% post-JOS, P<0.01) while confirmed infections remained stable. Meanwhile, ICU utilization decreased (7.8% of admissions pre-JOS vs. 4.9% post-JOS, P<0.01). The necessity for ICU care in children with hemophilia has decreased since publication of the JOS. However, expanded adoption of primary prophylaxis is associated with more hospitalizations for suspected systemic infections, likely due to utilization of central venous catheters to deliver clotting factor concentrates.

Exploring the association between sick child healthcare utilisation and health facility quality in Malawi: a cross-sectional study

ObjectiveIncreasing the availability of basic healthcare services in low-and middle-income countries is not sufficient to meet the Sustainable Development Goal target for child survival in high-mortality settings, where healthcare utilisation...

Maternal depression symptoms and use of child health-care services at The Pelotas 2004 Birth Cohort

ObjectiveTo investigate the influence of maternal depression on child health-care services utilization. MethodologyData from The Pelotas 2004 Birth Cohort collected at birth and at 12- and 24-month follow-ups were used. Four outcomes occurring in the second year of life were investigated: number of well-baby visits, number of medical appointments, number of visits to emergency rooms, and number of hospitalizations. The main exposure was maternal depression symptoms at 12-month post-partum as assessed by the Edinburgh Postpartum Depression Scale (EPDS). Adjusted prevalence ratios (PR) with 95% confidence intervals (95% CI) were calculated by Poisson regression. ResultsThe prevalence of mothers with depressive symptoms was 27.6% (95% CI: 26.2–29.0%). These mothers showed a 10% lower probability of taking their children to well-baby visits (0.90; 0.85–0.95; p = 0.001); 16% higher probability to seek medical consultations (1.16; 1.09–1.25, p = 0.001); and they sought emergency services for their children more often (1.30; 1.17–1.45, p < 0.001) as compared to mothers who did not present depressive symptoms. Although the PR for hospitalizations was 26% higher for children from mothers with depressive symptoms, the association did not achieve statistical significance (1.26; 0.98–1.63; p = 0.072). ConclusionChildren from mothers with depressive symptoms attend fewer number of preventive consultations. In contrast, they are taken to medical and emergency care more often, suggesting that these children are given healthcare when they are at more advanced stages of their illnesses.

Does Mental Health Parity Encourage Mental Health Utilization Among Children and Adolescents? Evidence from the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA).

This study examines the effects of mental health parity laws on mental health care utilization and mental health outcomes of children and adolescents from middle-income households in the context of the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA), using data from the 2007 and 2011-2012 waves of the National Survey of Children's Health (N = 57,549). A difference-in-differences method controlling for demographic characteristics, state Medicaid eligibility, and unemployment is used. The analyses show that after the enactment of the MHPAEA, children and adolescents with family income between 150 and 400% of the federal poverty level in states without prior parity laws experience a 2.80 percentage point relative increase (p< 0.01) in mental health care utilization. These children and adolescents also experience an increase in the diagnoses of anxiety, which may suggest that better access to healthcare increases screening for previously under-diagnosed disorders.

Demographics, healthcare utilization and drug use in children and adults with atopic dermatitis in Denmark: apopulation-based cross-sectional study.

Atopic dermatitis (AD) is a common inflammatory skin condition. While previous publications have examined healthcare expenses, large data regarding patient demographics, healthcare use and drug prescriptions are limited. To examine demographics, healthcare use and drug prescriptions in children and adults with hospital-diagnosed AD. Danish nationwide registries were cross-linked to access demographic, healthcare and drug prescription data on children and adults with hospital-diagnosed AD (ICD-10 code L20). The diagnostic code for AD used in this study was validated by reviewing medical charts. We identified 9704 children (time period 1997-2012) and 5558 adults (time period 1997-2007) with hospital-diagnosed AD. The diagnostic code L20 had a positive predictive value of 95%. Among children with AD, a larger proportion came from less resourceful families and had immigrant parents from non-European countries. In adults, we observed an opposite tendency. Topical and systemic antibiotics were used relatively frequent in both children and adults with AD. The use of prednisolone and other systemic anti-inflammatory therapy was substantially higher in adults with AD than in children. We were unable to identify and describe patients treated by general and private practitioners. There exist significant differences in social predictors for AD and the use of AD medication between children and adults with hospital-diagnosed AD in Denmark. The diagnostic code for AD appears to be valid in Danish registries.

Regional disparities in maternal and child health indicators: Cluster analysis of districts in Bangladesh.

Efforts to mitigate public health concerns are showing encouraging results over the time but disparities across the geographic regions still exist within countries. Inadequate researches on the regional disparities of health indicators based on representative and comparable data create challenges to develop evidence-based health policies, planning and future studies in developing countries like Bangladesh. This study examined the disparities among districts on various maternal and child health indicators in Bangladesh. Cluster analysis–an unsupervised learning technique was used based on nationally representative dataset originated from Multiple Indicator Cluster Survey (MICS), 2012–13. According to our results, Bangladesh is classified into two clusters based on different health indicators with substantial variations in districts per clusters for different sets of indicators suggesting regional variation across the indicators. There is a need to differentially focus on community-level interventions aimed at increasing maternal and child health care utilization and improving the socioeconomic position of mothers, especially in disadvantaged regions. The cluster analysis approach is unique in terms of the use of health care metrics in a multivariate setup to study regional similarity and dissimilarity in the context of Bangladesh.

Objectively measured physical activity and sedentary behaviour in children with bronchiectasis: a cross-sectional study

BackgroundBronchiectasis is a major contributor to respiratory morbidity and health care utilization in children and youth. Current treatment guidelines for bronchiectasis recommend participation in regular physical activity (PA) to improve aerobic fitness and quality of life (QoL). However, no previous study has assessed physical activity and sedentary behavior in this patient group, and the extent to which children with bronchiectasis meet guidelines for PA is unknown. In the absence of such data, we objectively measured the PA of children with bronchiectasis and compared them to current guidelines.MethodsForty-six children with bronchiectasis between 4 to 14 years (mean age 7.5 ± 2.6 years) were recruited from the Queensland Children’s Hospital, Brisbane. Daily time in sedentary, light, and moderate-to-vigorous PA (MVPA) was measured objectively over 7 days using the ActiGraph GT3X+ accelerometer and compared their values to current guidelines (minimum 60 min of MVPA daily). Compliance with the daily guideline and average daily steps counts were compared to normative data from two population–based health surveys of healthy children.ResultsWe had complete measurements from 36 children. On average, they accumulated 48.6 min of MVPA daily and were sedentary for ~ 7 h/day. There was no statistical difference in these values between sexes or weekdays vs. weekends. Only 2 (5.6%) children met the 60-min daily MVPA recommendation compared to 42.1% of healthy children. Children with bronchiectasis accumulated 8229 steps/day (boys: 8422 ± SD 473, girls: 8037 ± 594), well below the recommended 12,000 steps/day. In comparison, daily step counts in healthy children ranged from 11,500–14,500 steps/day.ConclusionChildren with bronchiectasis are insufficiently active for health benefit and would substantially benefit from programs to promote PA and reduce sedentary behavior.

Outcomes and Healthcare Utilization of Children with Mucopolysaccharidosis with and without Hematopoietic Stem Cell Transplantation

Introduction: Mucopolysaccharidosis Type I (MPS-I) is a lysosomal storage disease resulting in progressive multisystem involvement and ultimately death at a young age. Since 1980, hematopoietic stem cell transplant (HSCT) has been used to treat MPS-I and stabilize cognitive impairment. However, little is known regarding overall outcomes and healthcare utilization of HSCT compared to enzyme replacement therapy (ERT) versus other supportive treatments.Method: We utilized the Pediatric Health Information System, a validated multi-institutional pediatric and adolescent database from 45 individual pediatric institutions, to identify and analyze patients diagnosed with MPS-I between 2005 and 2017. A retrospective analysis was performed to examine outcomes and healthcare utilization between three cohorts: patients who received HSCT at less than one year old, patients who received HSCT at greater than one year old, and patients who did not receive HSCT.Results: In the largest reported cohort of 1,053 patients identified with MPS-I, approximately 15% received HSCT while others received ERT alone or supportive treatments. Approximately 23% of patients received HSCT at less than one year of age with the remainder of patients received HSCT at greater than one year of age (Table 1). There was no difference in incidence of acute graft versus host disease (GHVD) (p=0.980) between the younger (25.0%) and older (25.2%) transplant cohorts. In our sample, 12.2% of patients who received HSCT after one year of age were diagnosed with chronic GVHD in comparison to 5.6% of the younger cohort (p=0.364). There was no difference in likelihood of ICU admission when comparing non-HSCT management (53.9%) to both the younger (52.8%) and older (61.0%) HSCT cohorts (p=0.899, p=0.138 respectively). In both transplant cohorts the greatest likelihood of ICU admissions occurred during the first year post-transplant, after which the rate plateaued (see Figure 1). Infection was the most common reason for hospital admission among all patients, with severe infection being more common in both the younger HSCT cohort (OR 2.58, CI 1.32-5.04) and older HSCT cohort (OR 2.38, CI 1.62-3.49) when compared to non-HSCT management. When analyzing mortality between all cohorts, non-HSCT patients had a lower rate of mortality compared to patients who received HSCT at an older age (OR 3.50, CI 2.00-6.14). However, we found no difference in mortality between non-HSCT patients and HSCT at less than one year old (p=0.426). Approximately 50% of HSCT patients received ERT; we found no difference in overall survival between patients who received ERT and those who did not (p=0.796). Figure 2 shows the trend of MPS-I patients' first presentation to the hospital plotted alongside the incidence of HSCT in our sample between 2005 and 2017. When looking at the incidence of HSCT in relation to new presentations of MPS-I, a higher proportion of patients received HSCT during 2012-2017 (18.9%) as compared to 2005-2011 (12.6%) (p=0.005).Conclusion: When considering HSCT as treatment for MPS-I, HSCT at a younger age is associated with increased overall survival. This study found that ERT in addition to HSCT had no effect on overall mortality. The lack of difference between transplant and non-transplant ICU admissions indicates that HSCT does not significantly contribute to overall ICU admissions. Likelihood of ICU admission plateaus after one year, regardless of age at transplant. Infection is the most common reason for hospital admission for all patients with MPS-I diagnosis, however severe infection is more common among HSCT patients when compared to non-HSCT patients. First presentations to hospitals have down trended over the past several years while the number of HSCT each year has remained relatively stable, resulting in an increased proportion of HSCT incidence to new MPS-I presentations in hospital settings. One possible explanation is the recent implementation of newborn screening, which provides earlier detection of the disease. This may allow outpatient management at a young age and potentially avoid MPS-I manifestations resulting in hospital admissions. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Immunisation status of children presenting to the emergency department: Linkage of a longitudinal birth cohort with national immunisation data.

To describe the relationship between emergency department (ED) diagnosis of infectious disease and immunisation status in children ≤5 years. We also aimed to demonstrate feasibility of proof-of-concept linkage between disparate databases. Data from a cohort of 3404 children born in Southeast Queensland/Far North New South Wales between 2006 and 2011 were linked to Australian Childhood Immunisation Registry data and Emergency Department Information System data for presentations between 2006 and 2014. Immunisation status was assigned using the 2009 National Immunisation Program schedule. Of 1490 children (79% of those consented) with data on immunisation status, 87.2 and 84.6% were fully immunised by 12 and 24 months, respectively. Adding partially immunised children increased this to 93.2 and 91.4% at 12 and 24 months, respectively. Nearly two-thirds of all children made at least one ED presentation. Children presenting to ED with an infectious disease did not differ in immunisation status compared to children with other (non-infectious disease type) presentations but were younger, more likely to live with other children and had a longer ED stay and higher admission rate. Respiratory syncytial virus (RSV) was more frequently diagnosed in unimmunised children. In an existing birth cohort, immunisation rates were lower than the national average. RSV was more prevalent in unimmunised children presenting to ED, but immunisation status was not significantly associated with other infectious disease presentations. Linkage between national immunisation data and Australian ED data is feasible and has the potential to identify previously unrecognised factors related to child immunisation status and health-care utilisation.

Insurance transitions and healthcare utilization for children with refractory epilepsy

ObjectivesThe objective of the study is to investigate the association between insurance transitions and healthcare utilization among children with refractory epilepsy. MethodsWe applied published algorithms to identify the study cohort of children with a diagnosis of refractory epilepsy who were treated between 10/1/2013 and 9/30/2014 at 36 children's hospitals in the United States. Insurance transition was defined as having any change in the type of primary payer from the first date of diagnosis to the date of the last visit at the same hospital. Univariate and multilevel multivariable analytical methods were used in the study. ResultsAmong 3488 children hospitalized with refractory epilepsy, rates of insurance transitions at 1, 2, and 5 years of refractory epilepsy diagnosis were 8.1%, 14%, and 29.9%, respectively. Patients whose primary payer at diagnosis was Private or Others were more likely to experience insurance transitions than patients whose primary payer was Medicaid. Younger children were associated with a higher risk of insurance transitions than older children. The high intensity of insurance transitions was associated with a higher number of emergency department and inpatient visits. ConclusionsInsurance transitions interrupted the continuity of medical care for children with refractory epilepsy and were associated with more frequent hospitalizations and emergency department visits, which then translated to higher healthcare costs. Medicaid provided stable insurance coverage and is critically important for these patients and should be the main focus for policies aiming to minimize insurance transitions and optimize healthcare delivery.

Association between second hand smoke (SHS) exposure and caregiver stress in children with poorly controlled asthma

Objective: Urban children with asthma experience high rates of second hand smoke (SHS) exposure. The objective was to examine whether SHS exposure is associated with symptom frequency in children with poorly controlled asthma. Methods: Children were enrolled in a RCT to test the efficacy of an environmental control behavioral intervention versus an attention control group and followed over 12 months. SHS exposure assessed using salivary cotinine measurement. Frequency of child asthma symptoms, healthcare utilization, household smoking and caregiver daily life stress were obtained via caregiver report. Time of enrollment was recorded to assess seasonal factors. Symptom days and nights were the primary outcomes. Multivariable models and odds ratios examined factors that best predicted increased frequency of daytime/nighttime symptoms. Results: Children (n = 222) with a mean age of 6.3 (SD 2.7) years, were primarily male (65%), African American (94%), Medicaid insured (94%), and had poorly controlled asthma (54%). The final multivariable model indicated symptoms in the fall (OR 2.78; 95% CI 1.16, 6.52) and increased caregiver daily life stress (OR 1.13, 95% CI 1.02, 1.25) were significantly associated with increased symptom days when controlling for cotinine level, intervention status, child age and home and car smoking restrictions. Conclusions: There was no impact of SHS exposure on increased symptom frequency. High caregiver daily life stress and symptoms in fall season may place children with asthma at risk for increased day/nighttime symptoms. Close monitoring of symptoms and medication use during the fall season and intervening on caregiver life stress may decrease asthma morbidity in children with poorly controlled asthma.Trial registration: ClinicalTrials.gov identifier: NCT01981564.

Use of Large Data Sets in Evaluating Program Outcome in Pediatric Hearing Loss

IntroductionPermanent hearing loss (PHL) in childhood can profoundly impact development, with high economic costs to children and society. Hearing technology and service delivery advances, including universal newborn hearing screening implemented in Ontario in 2002 as part of the Infant Hearing Program (IHP), aim to improve outcomes of children with PHL.&#x0D; Objectives and ApproachWe examined the impact of IHP screening on age of identification of PHL, and compared healthcare utilization in children with and without PHL, in the Census Metropolitan Area of Ottawa. Children with PHL, identified from a database at the Children’s Hospital of Eastern Ontario, were linked to health administrative data housed at the Institute for Clinical Evaluative Sciences. Five residents of Ottawa acted as non-PHL controls for each PHL case. A regression discontinuity design (RDD) was used to investigate differences in age of identification pre- and post-IHP implementation. Poisson regression will compare healthcare utilization among children with and without PHL.&#x0D; ResultsReceipt of the HBPB was associated with reductions in low birth weight births (adjusted Relative Risk (aRR): 0.77; 95% CI: 0.63, 0.93) and preterm births (aRR: 0.78 (0.68, 0.90)), and increases in breastfeeding initiation (aRR: 1.05 (1.00, 1.09)) and large-for-gestational age births (aRR: 1.11 (1.01, 1.23)). HBPB receipt during pregnancy was also associated with increases in 1- and 2-year immunizations for FN children (aRR: 1.14 (1.09, 1.19), and aRR: 1.28 (1.19, 1.36), respectively). Reductions in the risk of being developmentally vulnerable in the language and cognitive domain of the EDI were also found for FN children whose mothers had received the HBPB during pregnancy (aRR: 0.85 (0.74, 0.97).&#x0D; Conclusion/ImplicationsIHP implementation resulted in earlier identificationof PHL in children, allowing earlier access to audiologic and habilitative services. However, children with PHL used the health system more often and in different ways from those without PHL. These results can support improvements in service delivery for children with PHL.