Trends in Regionalization of Hospital Care for Common Pediatric Conditions

We have previously observed that hospital care for children is concentrating significantly in Massachusetts. We now extend those observations to include 4 US states and give closer attention to the management patterns of specific clinical conditions. We used inpatient and emergency department admini...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2018-01, Vol.141 (1), p.e20171940
Main Authors: França, Urbano L, McManus, Michael L
Format: Article
Language:English
Subjects:
Abdominal Pain - diagnosis
Abdominal Pain - therapy
Adolescent
Analysis
Asthma - diagnosis
Asthma - epidemiology
Asthma - therapy
California
Child
Child Health Services - organization & administration
Child, Preschool
Children's hospitals
Company business planning
Female
Florida
Health Services Accessibility - statistics & numerical data
Hospitalization - statistics & numerical data
Hospitals
Hospitals, General - statistics & numerical data
Hospitals, Pediatric - statistics & numerical data
Hospitals, Voluntary
Humans
Male
Massachusetts
New York
Outcome Assessment (Health Care)
Pediatrics
Planning
Public health
Referral and Consultation - statistics & numerical data
Referral and Consultation - trends
Regional alliances
Regional medical programs
Regional Medical Programs - statistics & numerical data
Services
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Summary:We have previously observed that hospital care for children is concentrating significantly in Massachusetts. We now extend those observations to include 4 US states and give closer attention to the management patterns of specific clinical conditions. We used inpatient and emergency department administrative data sets from California, Florida, Massachusetts, and New York to measure transfer frequency and identify the site of care completion for >252 million hospital encounters from 2006 through 2013. We compared the concentration of pediatric care to adult care by using the Hospital Capability Index for all acute-care hospitals and quantified the regionalization of clinical conditions by using the Regionalization Index. The availability of hospital care was significantly more limited for children than adults in all 4 states (median Hospital Capability Index: 0.19 vs 0.74 in CA, 0.08 vs 0.79 in FL, 0.18 vs 0.69 in MA, and 0.16 vs 0.75 in NY). Between 2006 and 2011, care was concentrated for both adults and children but much more so for children. Although pediatric admissions decreased by 9.3% (from 545 330 to 494 645), interhospital transfers increased by 24.6% (from 64 285 to 80 101). The largest change in transfer rate was among children with common conditions, such as abdominal pain and asthma. Definitive pediatric hospital care is less available than adult care and is increasingly dependent on referral centers. This should be accounted for in public health plans, disaster preparedness, and determinations of network adequacy.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2017-1940