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Supply and utilization of pediatric subspecialists in the United States
Kristin N Ray1, Debra L Bogen2, Marnie Bertolet3
1Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; kristin.ray@chp.edu.
Insights
Children in areas with fewer pediatric subspecialists utilize care less and perceive less need, but disease burden remains similar. This impacts access to essential pediatric subspecialty services.
Area of Science:
- Pediatric healthcare access
- Healthcare disparities
- Subspecialty care utilization
Background:
- Geographic variation in pediatric subspecialty supply is a significant concern in the US.
- The impact of this variation on care utilization and patient outcomes is not well understood.
- Children with special health care needs are particularly vulnerable to these disparities.
Purpose of the Study:
- To examine the association between pediatric subspecialty supply and utilization, perceived need, and disease burden.
- To investigate how geographic availability of pediatric subspecialists affects access to care for children with special health care needs.
- To determine if lower subspecialty supply correlates with worse child or family disease burden.
Main Methods:
- Utilized data from the 2009-2010 National Survey of Children With Special Health Care Needs.
- Measured pediatric subspecialist supply as per capita rates at the county level.
- Analyzed the association between supply quintiles and parent-reported outcomes, controlling for confounders.
Main Results:
- Pediatric subspecialty supply varied widely, with some counties having zero specialists per 100,000 children.
- Children in the lowest supply quintiles were significantly less likely to have ambulatory subspecialty visits and perceive care needs.
- Conversely, those in low-supply areas had a higher likelihood of emergency department visits; no significant differences in overall disease burden were found.
Conclusions:
- Lowest pediatric subspecialty supply areas show decreased utilization and perceived need for care.
- Despite lower utilization, significant differences in child or family disease burden were not observed.
- Findings highlight disparities in access to pediatric subspecialty care, underscoring the need for improved geographic distribution.
Objective:
The wide geographic variation in pediatric subspecialty supply in the United States has been a source of concern. Whether children in areas with decreased supply receive less subspecialty care or have worse outcomes has not been adequately evaluated. Among children with special health care needs, we examined the association between pediatric subspecialty supply and subspecialty utilization, need, child disease burden, and family disease burden.
Methods:
We measured pediatric subspecialist supply as pediatric subspecialists per capita in each residential county. By using the 2009-2010 National Survey of Children With Special Health Care Needs and controlling for many potential confounders, we examined the association between quintile of pediatric subspecialty supply and parent-reported subspecialty utilization, perceived subspecialty need, and child and family disease burden.
Results:
County-level pediatric subspecialty supply ranged from a median of 0 (lowest quintile) to 59 (highest quintile) per 100 000 children. In adjusted results, compared with children in the highest quintile, children in the lowest quintile of supply were 4.8% less likely to report ambulatory subspecialty visits (P < .001), 5.3% less likely to perceive subspecialty care needs (P < .001), and 2.3% more likely to report emergency department visits (P = .018). There were no meaningful differences between pediatric subspecialty supply quintiles for other measures of child or family disease burden.
Conclusions:
Children living in counties with the lowest supply of pediatric subspecialists had both decreased perceived need for subspecialty care and decreased utilization of subspecialists. However, the differences in supply were not associated with meaningful differences in child or family disease burden.
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