Patient-centered interventions reduce Latino PICU deaths

A multilevel healthcare intervention to address the increased odds of mortality among Latino children admitted to a pediatric intensive care unit (PICU) significantly reduced these odds, an observational study indicates.

Investigators calculated mortality rates for white, African American, and Latino children discharged from a metropolitan hospital PICU from 2007 to 2009. After controlling for age, sex, major diagnostic categories, diagnosed infections, and insurance status, they found that Latino children had 3.7-fold higher odds of dying than white or African American children, who had similar odds to one another. The hospital then launched a comprehensive intervention to address these differences and studied its effect during a postintervention period from 2010 to 2012.

The intervention included the following components: education of healthcare professionals about culturally competent care; recruitment efforts to increase the number of bilingual staff; availability of 24-hour interpreter services in the ED and PICU; translation of consent forms and educational materials for patients and families; culturally sensitive end-of-life care discussions with participation of palliative care services; outreach efforts and contacts with the Latino community to remove barriers to healthcare access; and help from the city government and local health department for preventive services.

Investigators found that during the postintervention period, the odds of mortality were similar for all 3 groups-Latinos, whites, and African Americans. In other words, the chances of dying significantly decreased for Latinos while remaining the same for white and African American children. No other variables, including age, diagnosed infections, or insurance status, had any significant effect on this finding (Anand KJS, et al. JAMA Pediatr. 2015;169[4]:383-390).

Commentary

These are impressive results. I wonder why these interventions work. The researchers suggest future studies to measure the independent effects of each of their interventions. That information would be helpful in setting priorities as other institutions work to eliminate healthcare disparities in Latino and other minority populations. -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.