Opportunities for Restructuring Hospital Transfer Networks for Pediatric Asthma
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Published on: November 4, 2010
Lauren Brown1, Urbano L França1, Michael L McManus1
1Department of Anesthesiology, Critical Care and Pain Medicine, Division of Critical Care, Boston Children's Hospital, Harvard Medical School , Boston, Mass.
Insights
Pediatric asthma transfers often go to distant specialized centers, even when closer community hospitals have high care capability. A tiered system could improve care access and reduce tertiary center burden.
Area of Science:
- Pediatric Healthcare
- Pulmonology
- Health Services Research
Background:
- Pediatric asthma care involves a complex network of hospitals, including tertiary centers.
- Understanding current transfer patterns is crucial for optimizing care delivery.
- Tertiary centers often face significant patient loads, necessitating strategies for load balancing.
Purpose of the Study:
- To describe the current system of pediatric asthma care.
- To identify potential options for reducing the burden on tertiary care centers.
Main Methods:
- Retrospective, cross-sectional study analyzing 2014 administrative datasets.
- Included inpatient and emergency department encounters for children (<18 years) with a primary asthma diagnosis.
- Data from six US states: Arkansas, Florida, Kentucky, Maryland, Massachusetts, and New York.
Main Results:
- 174,239 pediatric asthma encounters, with 26,316 admissions and 3101 transfers.
- Most transfers (94.4%) were admitted, with a median stay of 2 days.
- 58.7% of 637 hospitals never admitted pediatric asthma patients; 8.5% regularly received transfers (highly capable pediatric centers).
- 32.8% of facilities did not regularly receive transfers but had high condition-specific capability (0.92).
- Transfer distances to specialized centers were greater than to potential receiving hospitals.
- Mean 2-day admission costs differed between receiving and potential receiving hospitals.
Conclusions:
- Nearly all acute care hospitals see pediatric asthma patients, but over half do not admit them.
- Transfers predominantly go to a few specialized centers, overlooking capable community hospitals.
- A tiered hospital care system for pediatric asthma may be feasible, especially with long transfer distances and crowded tertiary centers.
Objective:
To describe the current system of pediatric asthma care and identify potential options for unloading tertiary centers.
Methods:
Retrospective, cross-sectional study using 2014 inpatient and emergency department all-encounter administrative datasets from Arkansas, Florida, Kentucky, Maryland, Massachusetts, and New York. Study participants included children <18 with primary diagnosis of asthma.
Results:
There were 174,239 encounters for pediatric asthma, with 26,316 admissions and 3101 transfers. About 94.4% of transfers were admitted, with median stay length 2 days (interquartile range [IQR] 1.0-3.0). About 637 hospitals saw pediatric asthma, but 58.7% never admitted these patients. Fifty-four hospitals (8.5%) regularly received transfers; these hospitals were broadly capable pediatric centers (mean pediatric hospital capability indices = 0.82, IQR: 0.64-0.89). Two hundred nine facilities (32.8%) did not regularly receive transfers but were highly capable of caring for pediatric asthma (mean condition-specific capability = 0.92, IQR: 0.85-1.00). Median distance from transferring hospitals to the nearest pediatric center was 25.7 miles (IQR: 6.45-50.15) vs 18.0 miles (IQR: 8.35-29.25) to the nearest potential receiving hospital. Mean cost of a 2-day asthma admission in receiving hospitals was $3927 (IQR: $3083-$4894) versus $3427 (IQR: $2485-$4102) in potential receivers.
Conclusions:
While nearly all acute care hospitals encounter children with asthma, more than half never admit them. Children are primarily transferred to a small subset of specialized centers, despite the existence, in many regions, of closer community hospitals with high pediatric asthma capability. In settings with long transfer distances and tertiary center crowding, a tiered system of hospital care for pediatric asthma may be feasible.
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