Objectives There is considerable need to improve the effectiveness of healthcare to reduce morbidity and mortality. Child hospitalisations are influenced by determinants of health, including the home environment. Our aims were: (1) To investigate whether children hospitalised with potentially avoidable conditions thought to be associated with the home have an increased risk of rehospitalisation and death, (2) To investigate whether children hospitalised with particular subgroups of potentially avoidable conditions have an increased risk of rehospitalisation and death, (3) To assess the usefulness of these subgroups for identifying at-risk children.
Design We used four existing groups of potentially avoidable conditions developed based on expert opinion: 1. the potentially avoidable hospitalisations (PAH) group, associated with social/environmental conditions, 2. the potentially avoidable hospitalisations attributable (at least in part) to the home environment (PAHHE) group, 3. the crowding group, and 4. the Ministry of Health (MoH) group. We analysed national New Zealand hospital discharge data (2000–2014). Rehospitalisation and death were described using Kaplan-Meier curves. Group effectiveness for identifying at-risk children was assessed using Cox proportional hazard models with children hospitalised for non-PAH conditions as comparison.
Results In total, 1425085 hospital admissions occurred, for 683115 unique children. Rehospitalisation was relatively common (71.0%). Death was rare (0.6%). All groups performed moderately well identifying at-risk children. Children with PAH have increased risk of rehospitalisation (adjusted HR (aHR):2.30–3.60) and death (aHR:3.07–10.44). PAH group had highest sensitivity (75.1%). The MoH group has the highest positive predictive value (rehospitalisation: 86.2%, death: 2.5%).
Conclusions Children in the MoH group are very likely to benefit from housing interventions. Rehospitalisation and early mortality are useful assessment measures. Rehospitalisation exerts a considerable burden, and child deaths are catastrophic.
- health services research
- infectious Diseases
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Contributors JO carried out the analyses, drafted the initial manuscript and carried out revisions, and approved the final manuscript as submitted. TF assisted with carrying out the analyses, reviewed and revised the manuscript, and approved the final manuscript as submitted. AK critically reviewed the manuscript, provided feedback and approved the final manuscript as submitted. DAW critically reviewed the manuscript, provided feedback and approved the final manuscript as submitted. MGB assisted in the study design and guided the write up, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. NP conceptualised and designed the study, provided guidance on the statistical analyses, critically reviewed and revised the manuscript, and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Funding Lotteries Health Research (NZ) â€“ PhD scholarship awarded to JO. Health Research Council of New Zealand awarded a summer studentship research grant to TF through He Kainga Oranga translating housing research to practice for children's health (HRC15/429).
Competing interests None declared.
Ethics approval University of Otago Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
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