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Do pediatric hospitalizations have a unique geography?
Mark F Guagliardo1, Kathleen A Jablonski, Jill G Joseph
1Department of Prevention and Community Health, The George Washington University School of Public Health and Health Services, Washington, DC, USA. markg@gwu.edu
BMC Health Services Research
|January 23, 2004
Summary
Hospital service areas (HSAs) used for Medicare patients do not accurately represent children's healthcare needs. A unique system is needed for pediatric small-area analyses to improve health services research for all age groups.
Area of Science:
- Health Services Research
- Pediatric Healthcare Analysis
- Geographic Health Disparities
Background:
- Small-area health services research in the U.S. often relies on hospital service areas (HSAs) defined by the Dartmouth Atlas, primarily based on Medicare Part A patients (seniors).
- This methodology raises questions about its suitability for pediatric populations due to differing healthcare financing and provision systems for children in the U.S.
Purpose of the Study:
- To assess the necessity of a distinct HSA system for pediatric small-area analyses.
- To compare geographic hospitalization patterns between children and seniors in California.
Main Methods:
- Cross-sectional analysis of California hospital discharges for children (0-17 years) and seniors.
- Calculation of the index of localization (percentage of residents hospitalized in their home HSA) for both groups.
- Assessment of HSA agreement, the impact of local pediatric inpatient volume and resources, and visual comparison of traditional vs. pediatric-specific HSAs.
Main Results:
- The localization index for pediatric discharges was 20 percentage points lower than for Medicare cases, indicating a poor fit of traditional HSAs for children.
- Pediatric medical and surgical subgroups showed similar divergence from seniors.
- The location of children's hospitals and local pediatric bed supply were linked to the divergence between Medicare and pediatric hospitalization patterns.
Conclusions:
- Significant differences exist in the geographic hospitalization patterns of children and seniors in California.
- Medicare-based HSAs may not be appropriate for all age groups and healthcare services across the U.S.