Measures of Hospital Inclusivity Depend on Definitions of a Hospital's Catchment Area

Area of Science:

• Health Services Research
• Pediatric Healthcare Access
• Health Equity Studies

Background:

• Hospital inclusivity, defined as demographic concordance between a hospital and its patient population, is crucial for equitable healthcare delivery.
• Understanding how catchment area definitions influence hospital inclusivity is essential for assessing healthcare access and disparities.

Purpose of the Study:

• To examine the association between hospital inclusivity and various catchment area definitions in a pediatric emergency department (ED).
• To determine how race, ethnicity, and insurance status inclusivity scores change with different geographic boundaries.

Main Methods:

• A cross-sectional study analyzed data from 29,560 pediatric ED visits (ages 0-19) between 2021-2022.
• Catchment areas were defined using geodesic distances (1-100 km) and farthest patient-contributing census tracts.
• Inclusivity scores were calculated for racial, ethnic, and insurance subgroups, comparing hospital patient proportions to community proportions.

Main Results:

• Inclusivity varied significantly based on the catchment area definition.
• For Black patients, inclusivity scores ranged from -0.02 to 0.00 across different distances.
• Hispanic/Latino ethnicity and publicly insured patients showed higher inclusivity scores (0.00 to 0.12 and 0.02 to 0.12, respectively) with broader catchment definitions.

Conclusions:

• Hospital inclusivity is dynamic and not a fixed characteristic; it is influenced by the chosen catchment area.
• The findings underscore the importance of carefully defining service areas to accurately assess pediatric ED inclusivity.
• Further research is recommended to evaluate the reliability of inclusivity scores across diverse hospital settings.