Association between Child Opportunity Index and paediatric sepsis recognition and treatment in a large quality improvement collaborative: a retrospective cohort study.

Document Type

Article

Publication Date

1-19-2026

Identifier

DOI: 10.1136/bmjqs-2024-017844

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.

Journal Title

BMJ Qual Saf

Volume

35

Issue

2

First Page

106

Last Page

117

MeSH Keywords

Humans; Retrospective Studies; Quality Improvement; Sepsis; Female; Child; Male; Child, Preschool; Infant; Cross-Sectional Studies; Infant, Newborn; Healthcare Disparities; Adolescent

PubMed ID

40345682

Keywords

Collaborative, breakthrough groups; Healthcare quality improvement; Paediatrics; Trigger tools

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