{
  "abstract": "Background The Child Opportunity Index (COI) is a multidimensional measure of US neighbourhood-level conditions needed for healthy development. COI is associated with healthcare delivery and outcomes. Formal quality improvement (QI) may influence the relationship between COI, quality of care and outcomes in children.Objective To assess the association between COI and paediatric sepsis care delivery and outcomes and determine if baseline disparities in care change over time among hospitals in the Improving Pediatric Sepsis Outcomes (IPSO) collaborative.Methods Retrospective cohort study of IPSO patients probabilistically linked to the Pediatric Health Information System database from 2017 to 2021. Primary exposure was COI. We estimated differences in the proportions of patients in each COI quintile identified via standardised sepsis recognition protocols (screening tool, huddle documentation and/or order set use) and who received a bundle of recommended care (standardised sepsis recognition, plus bolus <1 hour and antibiotic <3 hours). We further assessed the timeliness of each bundle component and mortality. We evaluated changes in standardised sepsis recognition over time using generalised linear models.Results 31 260 sepsis cases from 24 hospitals were included. Cross-sectional analysis over the entire study period found patients in the Very High COI quintile were most likely to be identified via standardised recognition protocols and receive IPSO’s recommended care bundle (67.7% and 46%, respectively). Over time, standardised sepsis recognition improved for all; the greatest improvements were among inpatients in the Very Low COI quintile.Conclusion Disparities exist in paediatric sepsis care delivery by COI. Over the course of the IPSO collaborative, care improved most for children in the lowest COI quintile. QI collaboratives focused on standardisation and shared learning may reduce disparities.",
  "authors": [
    {
      "affiliations": [
        "Pediatric Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA",
        "Center for Quality and Patient Safety, Seattle Children’s, Seattle, Washington, USA"
      ],
      "name": "Lori Rutman"
    },
    {
      "affiliations": [
        "Children’s Hospital Association, Lenexa, Kansas, USA"
      ],
      "name": "Troy Richardson"
    },
    {
      "affiliations": [
        "Nationwide Children’s Hospital, Columbus, Ohio, USA"
      ],
      "name": "Jeffery Auletta"
    },
    {
      "affiliations": [
        "Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA",
        "The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Fran Balamuth"
    },
    {
      "affiliations": [
        "Pediatrics, University of Utah Health, Salt Lake City, Utah, USA",
        "Primary Children’s Hospital, Salt Lake City, Utah, USA"
      ],
      "name": "Amber Chambers"
    },
    {
      "affiliations": [
        "The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA",
        "Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Julie Fitzgerald"
    },
    {
      "affiliations": [
        "Pediatric Critical Care, Cook Children’s Medical Center, Fort Worth, Texas, USA"
      ],
      "name": "Javier Gelvez"
    },
    {
      "affiliations": [
        "Oklahoma Children’s Hospital, Oklahoma City, Oklahoma, USA"
      ],
      "name": "Karen A Genzel"
    },
    {
      "affiliations": [
        "Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA"
      ],
      "name": "Amy Grant"
    },
    {
      "affiliations": [
        "Pediatrics and Critical Care Medicine, Phoenix Children’s Hospital, Phoenix, Arizona, USA"
      ],
      "name": "Vishal Gunnala"
    },
    {
      "affiliations": [
        "St Jude Children’s Research Hospital, Memphis, Tennessee, USA"
      ],
      "name": "Hana Hakim"
    },
    {
      "affiliations": [
        "Children’s Mercy Hospital, Kansas City, Missouri, USA"
      ],
      "name": "Leslie Hueschen"
    },
    {
      "affiliations": [
        "Pediatrics, Critical Care Medicine, Yale School of Medicine, New Haven, Connecticut, USA"
      ],
      "name": "Sarah Kandil"
    },
    {
      "affiliations": [
        "Pediatric Critical Care, University of Utah, Salt Lake City, Utah, USA"
      ],
      "name": "Gitte Larsen"
    },
    {
      "affiliations": [
        "Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA"
      ],
      "name": "Justin Lockwood"
    },
    {
      "affiliations": [
        "Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"
      ],
      "name": "Kate Lucey"
    },
    {
      "affiliations": [
        "Pediatrics, Medical University of South Carolina College of Medicine, Charleston, South Carolina, USA"
      ],
      "name": "Elizabeth Mack"
    },
    {
      "affiliations": [
        "Boston Children’s Hospital Department of Anesthesiology Critical Care and Pain Medicine, Boston, Massachusetts, USA"
      ],
      "name": "Kate Madden"
    },
    {
      "affiliations": [
        "C S Mott Children’s Hospital, Ann Arbor, Michigan, USA"
      ],
      "name": "Matthew Niedner"
    },
    {
      "affiliations": [
        "Pediatric Emergency Medicine, Children’s Hospital of Orange County, Orange, California, USA"
      ],
      "name": "Raina Paul"
    },
    {
      "affiliations": [
        "Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"
      ],
      "name": "Anireddy Reddy"
    },
    {
      "affiliations": [
        "Children’s Hospital Association, Lenexa, Kansas, USA"
      ],
      "name": "Ruth Riggs"
    },
    {
      "affiliations": [
        "Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA",
        "Emergency Medicine, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA"
      ],
      "name": "Johanna Rosen"
    },
    {
      "affiliations": [
        "Pediatrics, State University of New York Upstate Medical University, Syracuse, New York, USA"
      ],
      "name": "Melissa Schafer"
    },
    {
      "affiliations": [
        "Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA",
        "Emergency Medicine, Children’s Hospital Colorado, Aurora, Colorado, USA"
      ],
      "name": "Halden Scott"
    },
    {
      "affiliations": [
        "Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA",
        "Division of Cancer and Blood Disorders, Seattle Children’s, Seattle, Washington, USA"
      ],
      "name": "Jennifer Wilkes"
    },
    {
      "affiliations": [
        "Pediatrics, Harvard Medical School, Boston, Massachusetts, USA",
        "Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA"
      ],
      "name": "Matthew A Eisenberg"
    },
    {
      "affiliations": [],
      "name": "Improving Pediatric Sepsis Outcomes Collaborative Investigators"
    }
  ],
  "title": "Association between Child Opportunity Index and paediatric sepsis recognition and treatment in a large quality improvement collaborative: a retrospective cohort study",
  "uid": "a4e0b85c-4dc1-59d5-aa01-40e0b98ccd45"
}