Trends in Regionalization of Hospital Care for Common Pediatric Conditions

Area of Science:

• Health Services Research
• Pediatric Health Services
• Healthcare Policy

Background:

• Hospital care for children in Massachusetts has been observed to be concentrating significantly.
• This study extends previous observations to four US states, examining pediatric care concentration and management patterns for specific clinical conditions.

Purpose of the Study:

• To analyze the concentration of pediatric hospital care compared to adult care across four US states.
• To investigate the management patterns and transfer frequency for pediatric clinical conditions between 2006 and 2013.

Main Methods:

• Utilized inpatient and emergency department administrative data from California, Florida, Massachusetts, and New York (>252 million encounters, 2006-2013).
• Measured transfer frequency and identified care completion sites.
• Compared pediatric care concentration to adult care using the Hospital Capability Index and quantified regionalization with the Regionalization Index.

Main Results:

• Hospital care availability was significantly more limited for children than adults across all four states.
• Between 2006 and 2011, pediatric care became more concentrated, with a 9.3% decrease in admissions but a 24.6% increase in interhospital transfers.
• The most significant increase in transfer rates was observed for children with common conditions like abdominal pain and asthma.

Conclusions:

• Definitive pediatric hospital care is less accessible than adult care and relies increasingly on referral centers.
• This growing concentration and dependence on referral centers must be factored into public health planning, disaster preparedness, and network adequacy assessments.