Hospital Access Patterns of Children With Technology Dependence

Area of Science:

• Pediatric Healthcare
• Health Services Research
• Medical Informatics

Background:

• Children with technology dependence (CTD) require complex, specialized care.
• Healthcare systems are increasingly concentrated, potentially affecting access for CTD.
• Understanding CTD hospital utilization is crucial for optimizing care delivery.

Purpose of the Study:

• To examine hospital utilization patterns among CTD.
• To investigate the relationship between pediatric healthcare concentration and travel distances for CTD care.
• To identify factors influencing healthcare navigation for CTD.

Main Methods:

• Utilized 2017 all-encounter datasets from six US states.
• Identified CTD by specific medical devices (tracheostomy, gastrostomy, shunt).
• Calculated Hospital Capability Indices and mapped patient-facility distances.

Main Results:

• 35% of hospitals never treated CTD; 70% of emergency visits and 85% of admissions occurred in high-capability centers.
• CTD traveled nearly four times farther than the nearest facility, bypassing closer options for higher-capability care.
• Sociodemographic factors (insurance, race, socioeconomic status) influenced access to high-capability centers and bypassing behavior.

Conclusions:

• CTD routinely bypass closer hospitals to access specialized pediatric care.
• This pattern leads to increased travel distances and unfamiliarity with CTD among many facilities.
• Sociodemographic disparities appear to influence care access and navigation for CTD.