{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T23:14:31Z","timestamp":1781133271525,"version":"3.54.1"},"reference-count":45,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2025,4,28]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 &lt;1\u2009hour and antibiotic &lt;3\u2009hours). We further assessed the timeliness of each bundle component and mortality. We evaluated changes in standardised sepsis recognition over time using generalised linear models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>31\u2009260 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\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjqs-2024-017844","type":"journal-article","created":{"date-parts":[[2025,5,9]],"date-time":"2025-05-09T02:30:22Z","timestamp":1746757822000},"page":"106-117","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Association between Child Opportunity Index and paediatric sepsis recognition and treatment in a large quality improvement collaborative: a retrospective cohort study"],"prefix":"10.1136","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7662-9695","authenticated-orcid":false,"given":"Lori","family":"Rutman","sequence":"first","affiliation":[{"name":"Pediatric Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA"},{"name":"Center for Quality and Patient Safety, Seattle Children\u2019s, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troy","family":"Richardson","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Association, Lenexa, Kansas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffery","family":"Auletta","sequence":"additional","affiliation":[{"name":"Nationwide Children\u2019s Hospital, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran","family":"Balamuth","sequence":"additional","affiliation":[{"name":"Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"},{"name":"The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber","family":"Chambers","sequence":"additional","affiliation":[{"name":"Pediatrics, University of Utah Health, Salt Lake City, Utah, USA"},{"name":"Primary Children\u2019s Hospital, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9936-9569","authenticated-orcid":false,"given":"Julie","family":"Fitzgerald","sequence":"additional","affiliation":[{"name":"The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA"},{"name":"Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0785-6302","authenticated-orcid":false,"given":"Javier","family":"Gelvez","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care, Cook Children\u2019s Medical Center, Fort Worth, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen A","family":"Genzel","sequence":"additional","affiliation":[{"name":"Oklahoma Children\u2019s Hospital, Oklahoma City, Oklahoma, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Grant","sequence":"additional","affiliation":[{"name":"Pediatrics, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8951-5925","authenticated-orcid":false,"given":"Vishal","family":"Gunnala","sequence":"additional","affiliation":[{"name":"Pediatrics and Critical Care Medicine, Phoenix Children\u2019s Hospital, Phoenix, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7146-5452","authenticated-orcid":false,"given":"Hana","family":"Hakim","sequence":"additional","affiliation":[{"name":"St Jude Children\u2019s Research Hospital, Memphis, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6930-2483","authenticated-orcid":false,"given":"Leslie","family":"Hueschen","sequence":"additional","affiliation":[{"name":"Children\u2019s Mercy Hospital, Kansas City, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2618-2119","authenticated-orcid":false,"given":"Sarah","family":"Kandil","sequence":"additional","affiliation":[{"name":"Pediatrics, Critical Care Medicine, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gitte","family":"Larsen","sequence":"additional","affiliation":[{"name":"Pediatric Critical Care, University of Utah, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1226-7947","authenticated-orcid":false,"given":"Justin","family":"Lockwood","sequence":"additional","affiliation":[{"name":"Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5757-291X","authenticated-orcid":false,"given":"Kate","family":"Lucey","sequence":"additional","affiliation":[{"name":"Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6913-6892","authenticated-orcid":false,"given":"Elizabeth","family":"Mack","sequence":"additional","affiliation":[{"name":"Pediatrics, Medical University of South Carolina College of Medicine, Charleston, South Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Madden","sequence":"additional","affiliation":[{"name":"Boston Children\u2019s Hospital Department of Anesthesiology Critical Care and Pain Medicine, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2755-6251","authenticated-orcid":false,"given":"Matthew","family":"Niedner","sequence":"additional","affiliation":[{"name":"C S Mott Children\u2019s Hospital, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raina","family":"Paul","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Medicine, Children\u2019s Hospital of Orange County, Orange, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7533-7204","authenticated-orcid":false,"given":"Anireddy","family":"Reddy","sequence":"additional","affiliation":[{"name":"Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3486-3413","authenticated-orcid":false,"given":"Ruth","family":"Riggs","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Association, Lenexa, Kansas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Rosen","sequence":"additional","affiliation":[{"name":"Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA"},{"name":"Emergency Medicine, Children\u2019s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4854-5564","authenticated-orcid":false,"given":"Melissa","family":"Schafer","sequence":"additional","affiliation":[{"name":"Pediatrics, State University of New York Upstate Medical University, Syracuse, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Halden","family":"Scott","sequence":"additional","affiliation":[{"name":"Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA"},{"name":"Emergency Medicine, Children\u2019s Hospital Colorado, Aurora, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3806-6019","authenticated-orcid":false,"given":"Jennifer","family":"Wilkes","sequence":"additional","affiliation":[{"name":"Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA"},{"name":"Division of Cancer and Blood Disorders, Seattle Children\u2019s, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2937-2222","authenticated-orcid":false,"given":"Matthew A","family":"Eisenberg","sequence":"additional","affiliation":[{"name":"Pediatrics, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Emergency Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,5,8]]},"reference":[{"key":"2026011903051244000_35.2.106.1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000225"},{"key":"2026011903051244000_35.2.106.2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-0188"},{"key":"2026011903051244000_35.2.106.3","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200703-480OC"},{"key":"2026011903051244000_35.2.106.4","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/S2352-4642(20)30341-2","article-title":"Hospital outcomes for children with severe sepsis in the USA by race or ethnicity and insurance status: a population-based, retrospective cohort study","volume":"5","author":"Mitchell","year":"2021","journal-title":"Lancet Child Adolesc Health"},{"key":"2026011903051244000_35.2.106.5","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2019-4113","article-title":"Race, Postoperative Complications, and Death in Apparently Healthy Children","volume":"146","author":"Nafiu","year":"2020","journal-title":"Pediatr"},{"key":"2026011903051244000_35.2.106.6","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2023-063714","article-title":"Disparities in Racial, Ethnic, and Payer Groups for Pediatric Safety Events in US Hospitals","volume":"153","author":"Parikh","year":"2024","journal-title":"Pediatr"},{"key":"2026011903051244000_35.2.106.7","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2022-006752"},{"key":"2026011903051244000_35.2.106.8","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003427"},{"key":"2026011903051244000_35.2.106.9","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1001\/jamapediatrics.2022.4396","article-title":"Assessment of Racial and Ethnic Disparities in Outcomes of Pediatric Hospitalizations for Sepsis Across the United States","volume":"177","author":"Li","year":"2023","journal-title":"JAMA Pediatr"},{"key":"2026011903051244000_35.2.106.10","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000002669"},{"key":"2026011903051244000_35.2.106.11","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000003842"},{"key":"2026011903051244000_35.2.106.12","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/S2352-4642(23)00251-1","article-title":"Racial and ethnic inequities in the quality of paediatric care in the USA: a review of quantitative evidence","volume":"8","author":"Slopen","year":"2024","journal-title":"Lancet Child Adolesc Health"},{"key":"2026011903051244000_35.2.106.13","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000001846"},{"key":"2026011903051244000_35.2.106.14","doi-asserted-by":"publisher","DOI":"10.1177\/0885066619885894"},{"key":"2026011903051244000_35.2.106.15","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2020.00581"},{"key":"2026011903051244000_35.2.106.16","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004375"},{"key":"2026011903051244000_35.2.106.17","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2018.05381"},{"key":"2026011903051244000_35.2.106.18","unstructured":"Noelke C , McArdle N , DeVoe B , et al . Child opportunity index 3.0 technical documentation. diversitydatakids.org, Brandeis University; 2024. Available: https:\/\/www.diversitydatakids.org\/research-library\/research-report\/coi-30-technical-documentation"},{"key":"2026011903051244000_35.2.106.19","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.30784","article-title":"Measures of Neighborhood Opportunity and Adherence to Recommended Pediatric Primary Care","volume":"6","author":"Ramachandran","year":"2023","journal-title":"JAMA Netw Open"},{"key":"2026011903051244000_35.2.106.20","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-024-05924-6"},{"key":"2026011903051244000_35.2.106.21","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2020-032755","article-title":"The Child Opportunity Index 2.0 and Hospitalizations for Ambulatory Care Sensitive Conditions","volume":"148","author":"Krager","year":"2021","journal-title":"Pediatr"},{"key":"2026011903051244000_35.2.106.22","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1001\/jamapediatrics.2023.3133","article-title":"Neighborhood Opportunity and Vulnerability and Incident Asthma Among Children","volume":"177","author":"Aris","year":"2023","journal-title":"JAMA Pediatr"},{"key":"2026011903051244000_35.2.106.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2023.04.011"},{"key":"2026011903051244000_35.2.106.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2023.01.006"},{"key":"2026011903051244000_35.2.106.25","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003191"},{"key":"2026011903051244000_35.2.106.26","doi-asserted-by":"publisher","DOI":"10.1016\/S1553-7250(10)36065-X"},{"key":"2026011903051244000_35.2.106.27","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2009-1100K"},{"key":"2026011903051244000_35.2.106.28","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-2982"},{"key":"2026011903051244000_35.2.106.29","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2020-045948E","article-title":"All Quality Improvement Is Health Equity Work: Designing Improvement to Reduce Disparities","volume":"149","author":"Lion","year":"2022","journal-title":"Pediatr"},{"key":"2026011903051244000_35.2.106.30","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2022-061176","article-title":"Hospital-Based Pediatric Quality Improvement Interventions and Health Disparities: A Scoping Review of the Literature","volume":"153","author":"Schechter","year":"2024","journal-title":"Pediatr"},{"key":"2026011903051244000_35.2.106.31","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2020-1434","article-title":"Development of a Quality Improvement Learning Collaborative to Improve Pediatric Sepsis Outcomes","volume":"147","author":"Larsen","year":"2021","journal-title":"Pediatr"},{"key":"2026011903051244000_35.2.106.32","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2020-017889","article-title":"Metric Development for the Multicenter Improving Pediatric Sepsis Outcomes (IPSO) Collaborative","volume":"147","author":"Paul","year":"2021","journal-title":"Pediatr"},{"key":"2026011903051244000_35.2.106.33","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004505"},{"key":"2026011903051244000_35.2.106.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2017.08.014"},{"key":"2026011903051244000_35.2.106.35","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1002\/pds.3241","article-title":"Merging of the National Cancer Institute-funded cooperative oncology group data with an administrative data source to develop a more effective platform for clinical trial analysis and comparative effectiveness research: a report from the Children\u2019s Oncology Group","volume":"21 Suppl 2","author":"Aplenc","year":"2012","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"2026011903051244000_35.2.106.36","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000001837"},{"key":"2026011903051244000_35.2.106.37","doi-asserted-by":"publisher","DOI":"10.1007\/s00467-018-4183-0"},{"key":"2026011903051244000_35.2.106.38","doi-asserted-by":"publisher","DOI":"10.12788\/jhm.2948"},{"key":"2026011903051244000_35.2.106.39","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2431-14-199","article-title":"Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation","volume":"14","author":"Feudtner","year":"2014","journal-title":"BMC Pediatr"},{"key":"2026011903051244000_35.2.106.40","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2014.0679"},{"key":"2026011903051244000_35.2.106.41","doi-asserted-by":"crossref","DOI":"10.1097\/pq9.0000000000000051","article-title":"A Quality Improvement Collaborative for Pediatric Sepsis: Lessons Learned","volume":"3","author":"Paul","year":"2018","journal-title":"Pediatr Qual Saf"},{"key":"2026011903051244000_35.2.106.42","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2022-059938","article-title":"Bundled Care to Reduce Sepsis Mortality: The Improving Pediatric Sepsis Outcomes (IPSO) Collaborative","volume":"152","author":"Paul","year":"2023","journal-title":"Pediatr"},{"key":"2026011903051244000_35.2.106.43","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1001\/jamapediatrics.2023.1379","article-title":"Identifying and Mitigating Disparities in Central Line-Associated Bloodstream Infections in Minoritized Racial, Ethnic, and Language Groups","volume":"177","author":"McGrath","year":"2023","journal-title":"JAMA Pediatr"},{"key":"2026011903051244000_35.2.106.44","doi-asserted-by":"crossref","unstructured":"Raman J , Johnson TJ , Hayes K , et al . Racial Differences in Sepsis Recognition in the Emergency Department. Pediatr 2019;144. doi:10.1542\/peds.2019-0348","DOI":"10.1542\/peds.2019-0348"},{"key":"2026011903051244000_35.2.106.45","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2023.12.008"}],"container-title":["BMJ Quality &amp; Safety"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjqs-2024-017844","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T11:05:48Z","timestamp":1768820748000},"score":1,"resource":{"primary":{"URL":"https:\/\/qualitysafety.bmj.com\/lookup\/doi\/10.1136\/bmjqs-2024-017844"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,8]]},"references-count":45,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1,19]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/bmjqs-2024-017844"],"URL":"https:\/\/doi.org\/10.1136\/bmjqs-2024-017844","relation":{},"ISSN":["2044-5415","2044-5423"],"issn-type":[{"value":"2044-5415","type":"print"},{"value":"2044-5423","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,8]]}}}