Identifying Areas With High Utilizers of Pediatric Health Care Across New York State in Real-World Practice, 2022: Implications for Health Care Delivery

Area of Science:

• Pediatric Health Services Research
• Public Health Policy
• Health Economics

Background:

• High utilization of pediatric healthcare services represents a significant financial and logistical burden.
• Understanding the geographic and demographic distribution of high utilizers is crucial for resource allocation.

Purpose of the Study:

• To analyze the distribution of high-utilizing children within New York State's healthcare system.
• To identify specific counties with disproportionately high rates of pediatric healthcare utilization.

Main Methods:

• Cross-sectional analysis of 2022 New York State inpatient and emergency department data for children under 18.
• Development of a composite adverse utilization index using principal component analysis to define high utilizers (top 5%).
• Application of negative binomial models to assess county-level variations in high utilizer rates.

Main Results:

• High utilizers constituted 5.0% of pediatric emergency department visits but accounted for 34.5% of hospital days, 57.3% of admissions, and 62.5% of costs.
• Children identified as high utilizers were more likely to have complex medical conditions and ambulatory care-sensitive conditions.
• Bronx and St. Lawrence counties exhibited significantly higher-than-expected rates of high pediatric healthcare utilizers.

Conclusions:

• The burden of pediatric healthcare in New York State is concentrated among a specific subset of children, often within particular counties.
• A reproducible utilization index can effectively guide the deployment of care coordination and community prevention initiatives.
• Findings support precision social medicine strategies by pinpointing areas of greatest need and potential impact.