title: Pediatric intensive care unit mortality among Latino children before and after a multilevel health care delivery intervention.
abstract: OBJECTIVE
  Research on health equity has focused on documenting health care disparities or understanding factors leading to disparities, but limited efforts have focused on reducing health care disparities in children. Latino children have increased prevalence of acute and chronic conditions; they have limited access and other barriers to high-quality health care, including intensive care.
  
  
  OBJECTIVE
  To determine whether pediatric intensive care unit mortality can be reduced by a multilevel health care delivery intervention.
  
  
  METHODS
  Observational study of factors associated with pediatric intensive care unit mortality at a tertiary care metropolitan children's hospital in Memphis, Tennessee. Participants were children younger than 18 years discharged from the pediatric intensive care unit during the 3-year preintervention period of 2007 to 2009 (n = 3891) and 3-year postintervention period of 2010 to 2012 (n = 4179).
  
  
  METHODS
  Multilevel health care intervention to address the increased odds of mortality among Latino children.
  
  
  METHODS
  The odds of mortality were analyzed over the 3-year preintervention period (2007-2009) using multivariable logistic regressions to control for age, sex, race/ethnicity, severity of illness, major diagnostic categories, diagnosed infections, and insurance status. Data from the postintervention period (2010-2012) were analyzed similarly to measure the effect of changes in health care delivery.
  
  
  RESULTS
  Unadjusted mortality rates for white, African American, and Latino children in 2007 to 2009 were 3.3%, 3.3%, and 8.6%, respectively. After controlling for covariates, no differences in the odds of mortality were observed between white children and African American children (odds ratio [OR], 1.0; 95% CI, 0.6-1.7; P = .97), but Latino children had 3.7-fold (95% CI, 1.8-7.5; P < .001) higher odds of mortality. A multilevel and multidisciplinary intervention was launched to address these differences. In the postintervention period, unadjusted mortality rates for white, African American, and Latino children were 3.6%, 3.2%, and 4.0%, respectively, with no differences observed after adjustment for covariates (OR, 0.7; 95% CI, 0.2-2.1; P = .49). The odds of mortality decreased between the preintervention period and postintervention period for Latino children (OR, 0.24; 95% CI, 0.06-0.88; P = .03) but remained unchanged for white and African American children (OR, 1.02; 95% CI, 0.73-1.43; P = .90).
  
  
  CONCLUSIONS
  Latino children had higher odds of mortality, even after controlling for age, sex, severity of illness, insurance status, and other covariates. These differences disappeared after culturally and linguistically sensitive interventions at multiple levels. Local multilevel interventions can reduce the effect of health care inequities on clinical outcomes, without requiring major changes in health care policy.
authors.affiliation: Department of Pediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis.
authors.forename: Kanwaljeet J S
authors.initials: KJ
authors.lastname: Anand
authors.affiliation: Decision Support Department, Le Bonheur Children's Hospital, Memphis, Tennessee3currently at Department of Performance Improvement and Patient Safety, Children's Hospital of The King's Daughters, Norfolk, Virginia.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sepanski
authors.affiliation: Decision Support Department, Le Bonheur Children's Hospital, Memphis, Tennessee.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Giles
authors.affiliation: Department of Pediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis.
authors.forename: Samir H
authors.initials: SH
authors.lastname: Shah
authors.affiliation: Research Center on Health Disparities, Equity, and the Exposome, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Juarez
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000706:statistics & numerical data; D002648:Child; D046688:Child Mortality / Q000208:ethnology* / Q000639:trends; D002675:Child, Preschool; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000208:ethnology* / Q000639:trends; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D016015:Logistic Models; D008297:Male; D009936:Organizational Innovation; D013714:Tennessee; D044465:White People / Q000706:statistics & numerical data