For Disadvantaged Children, Hospitalization May Improve QoL

For Disadvantaged Children, Hospitalization May Improve QoL
Research shows inpatient care can reduce health disparities.

Children hospitalized for three common respiratory illnesses whose families had markers of social disadvantage had a lower level of reported physical functioning prior to their inpatient stay, but those differences went away after discharge, according to a study published in the Journal of Hospital Medicine.

“Our goal was to explore ways in which social disadvantages and differences in access to care might impact physical functioning and health-related quality of life for kids both before and after a period of inpatient care,” said David P. Johnson, M.D., an associate professor of pediatrics at Monroe Carell Jr. Children’s Hospital at Vanderbilt and coauthor on the study.¹

Most prior studies establishing that children with social disadvantages have lower levels of functioning, as measured by health-related quality of life (HRQoL) scores, have been done in outpatient settings, Johnson said.

Functioning Before and After Inpatient Care

Over a two-year period, the researchers approached families with a child between 2 weeks and 16 years of age admitted to the hospital due to asthma, bronchiolitis or pneumonia to request participation in the study.

In total, 1,325 patients and/or their caregivers participated. Twenty-two percent of patients had three or more social disadvantages.²

The researchers used two surveys to measure HRQoL by obtaining Pediatric Quality of Life (PedsQL) scores ranging between 0 and 100. The first survey, administered within 72 hours of admission, asked about markers of social disadvantage, caregivers’ perceptions of care access, and assessment of the child’s physical functioning by the caregiver (or by the child if 8 years of age or older). The second PedsQL physical functioning survey was administered 2-8 weeks after discharge.

Children with three or more social disadvantages had an average PedsQL score of 78.7 at admission while children with no such disadvantages averaged 85.5. “Prior research has established that differences in scores of at least 4.5 are clinically meaningful,” Johnson said. In the post-discharge survey, physical functioning scores were comparable between groups. Across all participants, the mean post-discharge PedsQL score was higher than the baseline score (90.4 versus 82.5).

In both surveys, difficulties or delays in care access were associated with lower PedQL scores, but such issues were not a significant effect modifier between social disadvantage and PedQL scores.

Potential to Build on Inpatient Experience

The authors hypothesize that hospitalization may provide additional opportunities to address social determinants for vulnerable families. It provides a setting where families can interact often with clinicians and other staff to discuss health concerns and express unmet needs, and potentially connect with a primary care provider (PCP), social services or community resources.

As the study did not address how or why experiences during the stay changed PedsQL perceptions, Johnson hopes that future research will clarify that issue.

“We need to better understand why these perceptions are different before the children come in, and what we did for them in the hospital that changed those perceptions. This understanding will inform how we can become more systematic in ensuring that we meet families’ needs.”

“We need to better understand why these perceptions are different before the children come in, and what we did for them in the hospital that changed those perceptions.”