Characteristics of United States Rural Hospitals by General Pediatric Care Availability, 2023

Access to pediatric inpatient care continues to decline in rural areas, yet the characteristics of hospitals providing general pediatric care remain insufficiently defined. This study examines hospital factors associated with general pediatric configurations in rural United States hospitals.

We conducted a cross-sectional analysis using 2023 American Hospital Association Annual Survey and Center for Medicare and Medicaid's Provider of Service files. Rurality was defined using 2020 Rural-Urban Commuting Area codes. Hospitals were categorized into 4 mutually exclusive configurations: newborn care only, general pediatric care only, both, and none. Multinomial logistic regression evaluated hospital characteristics associated with each configuration relative to hospitals offering neither service. A secondary logistic regression assessed whether newborn services were associated with the availability of general pediatric care.

Among 2180 rural hospitals, 1607 (73.7%) offered some pediatric services: 6.5% (N = 105) offered newborn-only care, 32.7% (N = 525) offered general pediatric care only care, and 60.8% (N = 977) offered both services. Hospitals offering both services had markedly higher odds of adult surgical services (adjusted relative risk ratio [aRRR] 10.20; 95% CI 6.36-16.37) and adult intensive care (aRRR 5.53; 95% CI 3.77-8.11) relative to hospitals with neither service. Larger bed capacity was associated with increasing odds of dual-service availability. In the secondary model, hospitals offering newborn care had significantly higher odds of offering general pediatric services (adjusted odds ratio 4.2; 95% CI, 3.2-5.7).

Distinct structural, geographic, and capacity-related characteristics differentiate pediatric service configurations in rural hospitals. Policies that support integrated maternal-child services may help sustain rural pediatric access.