Hospitalization Patterns for Rural-Residing Children from 2002 to 2017

Area of Science:

• Pediatric Health Services Research
• Rural Health Disparities
• Healthcare Access and Quality

Background:

• The closure of inpatient pediatric units contributes to the regionalization of pediatric care.
• Geographic distance to healthcare facilities impacts care quality for rural children and families.
• Rural community disaster preparedness is influenced by healthcare access.

Purpose of the Study:

• To assess trends in hospitalization locations for children residing in rural areas over time.
• To analyze shifts in pediatric inpatient care utilization among rural populations.
• To understand the implications of changing hospitalization patterns on rural healthcare access.

Main Methods:

• Analysis of 256,947 hospitalizations for rural children (0-17 years) across eight states (2002-2017) using State Inpatient Databases.
• Classification of rurality using Rural-Urban Commuting Area Codes (micropolitan, small rural, isolated rural).
• Assessment of trends in hospitalization location, interfacility transfers (IFTs), and local-area agreement using Cochran-Armitage trend test.

Main Results:

• A 52.7% decrease in hospitalizations for rural children from 2002-2017.
• A significant increase in interfacility transfers (IFTs) from 6.7% to 26.5%.
• A rise in metropolitan area hospitalizations for rural children (32.2% to 72.8%) and a decrease in local-area care utilization (53.6% to 21.5%).

Conclusions:

• Despite an overall decrease in hospitalizations, rural children are increasingly hospitalized in metropolitan areas, often via IFTs.
• The observed shift in inpatient health services may affect the efficiency and quality of care for rural pediatric populations.
• Further research is needed to explore the impact of these trends on rural children's health outcomes and healthcare equity.