Accountable Care Organizations, Child Opportunity Index, and Complicated Appendicitis in Children

Introduction: Child Opportunity Index (COI) is associated with complicated appendicitis (CA) in children. Value-based care through an accountable care organization (ACO) may modify this association. We aimed to determine if enrollment in our state's ACO, Partners For Kids (PFK), modified the association between COI and CA. Methods: Using a single-institution, retrospective review of children with public insurance undergoing appendectomy for acute appendicitis, COI and clinical confounders were compared by simple versus CA. Multivariable logistic regression models using COI, insurance, and age were fit with and without interaction terms to determine if PFK enrollment modified the association between COI and CA. Results: Among 1337 children, 31.0% had CA. Most (78.6%) were enrolled in PFK; this was not different between simple and CA. CA was associated with younger median age (7.0 y versus 8.0 y, P < 0.001). As overall COI quintile decreased (lower opportunity), the percentage of children with CA increased (P = 0.01). On multivariable regression controlling for age, PFK, and COI, only Very Low COI and age remained significantly associated with CA. The association between COI and CA was not modified by PFK enrollment. COI and PFK enrollment were not associated with postoperative complications, except children with PFK had fewer 30-d readmissions (4.2% versus 14.6%, P < 0.001) compared to those with other public insurance. Conclusions: Low COI was associated with higher CA, and this association was not modified by enrollment in an ACO, suggesting that ACO enrollment alone may not be sufficient in addressing social determinants of health among children with CA.