A National Analysis of General Pediatric Inpatient Unit Closures and Openings, 2011-2018

Area of Science:

• Healthcare Management
• Pediatric Health Services Research
• Health Economics

Background:

• Understanding trends in pediatric inpatient unit (GPI) closures and openings is crucial for assessing access to pediatric care.
• Factors influencing these changes, such as hospital financial status and ownership structure, require detailed investigation.

Purpose of the Study:

• To analyze the frequency and net rates of general pediatric inpatient (GPI) unit closures and openings nationally and by state.
• To determine the proportion of closures/openings driven by GPI unit-specific versus hospital-level changes.
• To examine the relationship between hospital financial status, system ownership, and GPI unit closures or openings.

Main Methods:

• Utilized the Health Systems and Providers Database (2011-2018) and additional hospital closure data.
• Calculated net rates of change for GPI unit closures and openings.
• Employed multinomial logistic regressions to assess associations between financial distress, system ownership, and GPI unit closure/opening likelihood, controlling for hospital characteristics.

Main Results:

• A net closure rate of 2.0% was observed, with 15.7% of GPI units closing versus 13.7% opening.
• Most GPI unit closures (89.0%) occurred in hospitals that continued to operate.
• Hospitals owned by systems were significantly less likely to close GPI units (OR: 0.66), while financial distress was not a significant factor (OR: 1.01).

Conclusions:

• More general pediatric inpatient units closed than opened during the study period, primarily in hospitals that remained operational.
• Hospital system ownership, not overall financial distress, was associated with a lower likelihood of GPI unit closures.
• Findings suggest system affiliation may buffer against GPI unit closures, impacting the distribution of pediatric services.