{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T21:48:53Z","timestamp":1793828933792,"version":"4.6.1"},"reference-count":40,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2024,7,16]],"date-time":"2024-07-16T00:00:00Z","timestamp":1721088000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2024,7,16]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The interstage period after discharge from stage 1 palliation carries high morbidity and mortality. The impact of social determinants of health on interstage outcomes is not well characterized. We assessed the relationship between childhood opportunity and acute interstage outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>Infants discharged home after stage 1 palliation in the National Pediatric Quality Improvement Collaborative Phase II registry (2016\u20132022) were retrospectively reviewed. Zip code\u2013level Childhood Opportunity Index (COI), a composite metric of 29 indicators across education, health and environment, and socioeconomic domains, was used to classify patients into 5 COI levels. Acute interstage outcomes included death or transplant listing, unplanned readmission, intensive care unit admission, unplanned catheterization, and reoperation. The association between COI level and acute interstage outcomes was assessed using logistic regression with sequential adjustment for potential confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      The analysis cohort included 1837 patients from 69 centers. Birth weight (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001) and proximity to a surgical center at birth (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.02) increased with COI level. Stage 1 length of stay decreased (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.001), and exclusive oral feeding rate at discharge increased (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001), with higher COI level. More than 98% of patients in all COI levels were enrolled in home monitoring. Death or transplant listing occurred in 101 (5%) patients with unplanned readmission in 987 (53%), intensive care unit admission in 448 (24%), catheterization in 345 (19%), and reoperation in 83 (5%). There was no difference in the incidence or time to occurrence of any acute interstage outcome among COI levels in unadjusted or adjusted analysis. There was no interaction between race and ethnicity and childhood opportunity in acute interstage outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Zip code COI level is associated with differences in preoperative risk factors and stage 1 palliation hospitalization characteristics. Acute interstage outcomes, although common across the spectrum of childhood opportunity, are not associated with COI level in an era of highly prevalent home monitoring programs. The role of home monitoring in mitigating disparities during the interstage period merits further investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.124.069127","type":"journal-article","created":{"date-parts":[[2024,6,19]],"date-time":"2024-06-19T05:00:31Z","timestamp":1718773231000},"page":"190-202","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Childhood Opportunity and Acute Interstage Outcomes: A National Pediatric Cardiology Quality Improvement Collaborative Analysis"],"prefix":"10.1161","volume":"150","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1052-9736","authenticated-orcid":true,"given":"Benjamin","family":"Zielonka","sequence":"first","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital and Department of Pediatrics, Harvard Medical School, MA (B.Z., M.L., L.A.S., D.W.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2815-3597","authenticated-orcid":true,"given":"Emily M.","family":"Bucholz","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Department of Pediatrics, Children\u2019s Hospital Colorado, University of Colorado, Denver (E.M.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minmin","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital and Department of Pediatrics, Harvard Medical School, MA (B.Z., M.L., L.A.S., D.W.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2844-7520","authenticated-orcid":true,"given":"Katherine E.","family":"Bates","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children\u2019s Hospital, University of Michigan, Ann Arbor (K.E.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0050-7250","authenticated-orcid":true,"given":"Garick D.","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cincinnati Children\u2019s Hospital Medical Center, OH (G.D.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelangi M.","family":"Pinto","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, Seattle Children\u2019s Hospital, University of Washington, WA (N.M.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8055-768X","authenticated-orcid":true,"given":"Lynn A.","family":"Sleeper","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital and Department of Pediatrics, Harvard Medical School, MA (B.Z., M.L., L.A.S., D.W.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8406-5957","authenticated-orcid":true,"given":"David W.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Boston Children\u2019s Hospital and Department of Pediatrics, Harvard Medical School, MA (B.Z., M.L., L.A.S., D.W.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.05.020"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.014548"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.009145"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.115.002376"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.05.100"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.semtcvs.2016.08.011"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.000488"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0912461"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2021.05.048"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.025358"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2012.03.050"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.2436"},{"key":"e_1_3_3_14_2","volume-title":"Child Opportunity Index 2.0 Technical Documentation","author":"Noelke C","year":"2020","unstructured":"Noelke, C, McArdle, N, Baek, M, Huntington, N, Huber, R, Hardy, E, Acevedo-Garcia, D. 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