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Acute care utilization disparities among publicly insured preterm infants

Pediatric Research volume 90, pages 717–719 (2021)Cite this article

In its 2003 landmark document Unequal Treatment, the Institutes of Medicine reported that racial and ethnic disparities in health care delivery and quality of care exist despite controlling for socioeconomic differences for persons of color, and further concluded that discrimination at the individual and patient-provider level involving bias, stereotyping and uncertainty in clinical communication and family-centered decision making have substantial impacts on such disparities.1 Unfortunately, similar disparities and resultant variability in care delivery have also been demonstrated for preterm infants, a population that is already at high risk for vulnerability from a health standpoint. In addition, these disparities can be attributed to differential care based upon race and ethnicity, but are also further compounded by the care provided in low versus high quality neonatal intensive care unit (NICU) settings, defined by using hospital-level NICU quality measures, such as healthcare-associated bacterial or fungal infections, discharge on human breast milk, mortality during the birth hospitalization and growth velocity.2,3 Several community-level factors influence families receiving care at lower quality NICUs, including residential segregation, poverty, health care access, language barriers, and health insurance coverage. While there have been strides in recognition of racial and ethnic disparities in health care delivery, unfortunately, systemic racism within healthcare continues to serve as a primary barrier toward further progress.4,5,6 High-cost health care utilization, such as repeated emergency room visits by publicly insured patients has been well established, and further mirrors societal barriers to equitable access to care.7 Kuzniewicz et al. revealed in comparing emergency department (ED) utilization by moderate preterm, late preterm, and early term infants after discharge from NICU, there was no significant difference in emergency department utilization based upon gestational age, but there was increased ED use by Black and Hispanic infants.8

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Authors and Affiliations

  1. Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Mona Patel

  2. Center for Child Health Policy and Advocacy, Baylor College of Medicine, Houston, TX, USA

    Jean L. Raphael

  3. New York Medical College, Valhalla, NY, USA

    Shetal Shah

  4. Baylor College of Medicine, Houston, TX, USA

    Jean L. Raphael

  5. University of Southern California, Los Angeles, CA, USA

    Mona Patel

  6. Tufts Medical Center, Boston, MA, USA

    Jonathan Davis

  7. Harvard Medical School, Boston, MA, USA

    DeWayne Pursley & Lois Lee

  8. University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Tina Cheng

  9. University of California Los Angeles, Los Angeles, CA, USA

    Sherin Devaskar

  10. American Academy of Pediatrics, University of Southern California, Los Angeles, CA, USA

    Joyce Javier

  11. Federal Advocacy, Washington, DC, USA

    James Baumberger & Matt Mariani

  12. University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada

    Lisa Robinson

  13. Stanford University School of Medicine, Stanford, CA, USA

    Mary Leonard

  14. University of Colorado School of Medicine, Aurora, CO, USA

    Shale Wong

  15. George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Beth Tarini & Monika Goyal

Authors
  1. Mona Patel
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  2. Jean L. Raphael
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Consortia

on behalf of the Pediatric Policy Council

  • Shetal Shah
  • , Jean L. Raphael
  • , Mona Patel
  • , Jonathan Davis
  • , DeWayne Pursley
  • , Tina Cheng
  • , Sherin Devaskar
  • , Joyce Javier
  • , Lois Lee
  • , James Baumberger
  • , Matt Mariani
  • , Lisa Robinson
  • , Mary Leonard
  • , Shale Wong
  • , Beth Tarini
  •  & Monika Goyal

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Correspondence to Mona Patel.

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Patel, M., Raphael, J.L. & on behalf of the Pediatric Policy Council. Acute care utilization disparities among publicly insured preterm infants. Pediatr Res 90, 717–719 (2021). https://doi.org/10.1038/s41390-021-01703-3

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  • DOI: https://doi.org/10.1038/s41390-021-01703-3

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