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Pulse Oximetry Screening: Association of State Mandates with Emergency Hospitalizations

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Abstract

We evaluated the association between implementation of state-mandated pulse oximetry screening (POS) and rates of emergency hospitalizations among infants with Critical Congenital Heart Disease (CCHD) and assessed differences in that association across race/ethnicity. We hypothesized that emergency hospitalizations among infants with CCHD decreased after implementation of mandated POS and that the reduction was larger among racial and ethnic minorities compared to non-Hispanic Whites. We utilized statewide inpatient databases from Arizona, California, Kentucky, New Jersey, New York, and Washington State (2010–2014). A difference-in-differences model with negative binomial regression was used. We identified patients with CCHD whose hospitalizations between three days and three months of life were coded as “emergency” or “urgent” or occurred through the emergency department. Numbers of emergency hospitalizations aggregated by month and state were used as outcomes. The intervention variable was an implementation of state-mandated POS. Difference in association across race/ethnicity was evaluated with interaction terms between the binary variable indicating the mandatory policy period and each race/ethnicity group. The model was adjusted for state-specific variables, such as percent of female infants and percent of private insurance. We identified 9,147 CCHD emergency hospitalizations. Among non-Hispanic Whites, there was a 22% (Confidence Interval [CI] 6%–36%) decline in CCHD emergency hospitalizations after implementation of mandated POS, on average. This decline was 65% less among non-Hispanic Blacks compared to non-Hispanic Whites. Our study detected an attenuated association with decreased number of emergency hospitalizations among Black compared to White infants. Further research is needed to clarify this disparity.

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Acknowledgements

This study utilized 2010–2014 data from Arizona, Kentucky, New Jersey, New York, and Washington Statewide Inpatient Databases (SID), Healthcare Cost and Utilization Project (HCUP), compiled by the Agency for Healthcare Research and Quality. This study also utilized 2010–2014 Patient Discharge Data (PDD) from California’s Office of Statewide Healthcare Planning and Development (OSHPD). The authors would like to acknowledge HCUP SID partners: https://www.hcup-us.ahrq.gov/partners.jsp?SID#:~:text=HCUP%20Partners&text=The%20SID%20are%20a%20set,Federal%2DState%2DIndustry%20partnership

Funding

Rie Sakai-Bizmark is funded by an NIH Research Scientist Development award (NHLBI K01141697). The contents of this work are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA, 90502, USA

    Rie Sakai-Bizmark, Emily H. Marr, Lauren E. M. Bedel, Laurie A. Mena, Dennys Estevez, Frank Wu & Ruey-Kang R. Chang

  2. Department of Pediatrics, Harbor-UCLA Medical Center and the David Geffen School of Medicine, University of California, Los Angeles (UCLA), Torrance, CA, USA

    Rie Sakai-Bizmark, Anita Baghaee, Michael Nguyen & Ruey-Kang R. Chang

  3. Department of Healthcare Quality Assessment, The University of Tokyo School of Medicine, Tokyo, Japan

    Hiraku Kumamaru

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  1. Rie Sakai-Bizmark
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Correspondence to Rie Sakai-Bizmark.

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Conflict of interest

Dr. Chang is the founder, CEO, and majority shareholder of QT Medical. QT Medical manufactures ECG devices. Dr. Chang is also the founder and CEO of NeoVative, a Research & Development company for wearable medical devices. The authors declare that there is no conflict of interest regarding the study.

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The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the 1964 Declaration of Helsinki and its later amendment. The study was approved by Lundquist Institute for Biomedical Innovation IRB (18CR-32121-01).

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Sakai-Bizmark, R., Kumamaru, H., Marr, E.H. et al. Pulse Oximetry Screening: Association of State Mandates with Emergency Hospitalizations. Pediatr Cardiol 44, 67–74 (2023). https://doi.org/10.1007/s00246-022-03027-3

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