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Access to Pediatric Bed Capacity According to Social Determinants of Health: All Beds Are Not Created Equal
Thomas A Hegland1, R Thomas Day2, Katie M Moynihan3
1Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD.
Insights
Pediatric hospital bed capacity is equitable across social determinants of health. However, hospitals in disadvantaged areas have fewer resources and capabilities, indicating a need for equitable resource allocation.
Area of Science:
- Pediatric Healthcare
- Health Services Research
- Health Equity
Background:
- Understanding pediatric inpatient hospital capacity and resource allocation is crucial for ensuring equitable healthcare access.
- Social Determinants of Health (SDoH) significantly influence health outcomes and resource distribution.
- Market share techniques offer a novel approach to analyzing hospital capacity and capabilities relative to patient populations.
Purpose of the Study:
- To analyze pediatric inpatient hospital capacity and resources.
- To characterize disparities in capacity and resources based on Social Determinants of Health (SDoH).
- To utilize market share techniques for a nuanced understanding of hospital capabilities.
Main Methods:
- A cross-sectional study analyzing nonelective inpatient discharges for patients aged 1 month to 19 years.
- Data sourced from Healthcare Cost and Utilization Project and American Hospital Association surveys.
- Hospital capacity, resources (capital, expenditure, staffing), transfer rates, payer-mix, and infection rates were calculated per bed.
- SDoH were derived from American Community Survey and Child Opportunity Index (COI).
Main Results:
- Pediatric bed capacity per capita was consistent across racial and ethnic groups, with higher capacity in socially disadvantaged areas.
- Hospitals serving minority, disadvantaged, and rural populations had lower per-bed capital, expenditure, and staffing.
- These hospitals also exhibited higher transfer rates and a greater proportion of Medicaid enrollees.
- Central line-associated blood stream infection rates did not significantly differ by SDoH.
Conclusions:
- While pediatric bed capacity is evenly distributed across SDoH, resource and capability disparities persist.
- Hospitals serving under-represented and disadvantaged communities face significant resource limitations.
- Further research is needed to guide equitable resource allocation strategies to address these disparities.
Objective:
To study pediatric inpatient hospital capacity and resources, characterizing differences according to Social Determinants of Health (SDoH) using market share techniques.
Study Design:
This cross-sectional study uses nonelective inpatient discharges (≥1 month to ≤19 years) from Healthcare Cost and Utilization Project and American Hospital Association surveys to derive hospital capacity and resources/capability. We include US hospitals with ≥1 pediatric bed and ≥1 pediatric discharge and calculate per bed capital, expenditure, and staffing, transfer rates, payer-mix, and adjusted central line-associated blood stream infection rate. We utilize actual discharge data to improve upon traditional geospatial access analyses that assume all patients receive care close to home. SDoH are derived from American Community Survey measures (family income, race and ethnicity, and urban vs rural) and Child Opportunity Index (COI).
Results:
Using 1 118 502 discharges across 1404 hospitals, mean pediatric bed capacity was 3.26 beds per 10 000 pediatric-aged residents (95% CI: 3.24-3.29). Capacity was similar across racial and ethnic groups, although socially disadvantaged (low income or COI) areas had higher capacity. Hospitals serving non-Hispanic/Latino Black and Hispanic/Latino children, children from socially disadvantaged communities, and rural areas had lower capital, expenditure, and staff per bed; higher transfer rates; and served more Medicaid enrollees. Hospitals serving very-high COI areas had $284 000 greater expenditure per bed (vs very low) and a 16% lower proportion of Medicaid patients. Central line-associated blood stream infection rates did not substantively differ by SDoH.
Conclusions:
Although pediatric bed capacity was evenly distributed according to SDoH, hospitals serving under-represented, disadvantaged, and rural communities had less capability and resource availability. Future work is required to guide equity-oriented resource allocation.
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