Trends in Regionalization of Pediatric Inpatient and Critical Care by Medical Complexity

Pediatric inpatient and critical care services are increasingly regionalizing: shifting from smaller hospitals to larger specialty centers. Children with medical complexity (CMC) and with technology dependence (TD) account for a disproportionate share of these services, but it is unknown whether regionalization has evolved differently for these groups compared with children without medical complexity.

We conducted a retrospective cohort study of all pediatric inpatient and non-cardiac/neonatal intensive care unit encounters in 6 states from 2001 to 2022. We calculated the proportion of hospitals providing these services, the distribution of encounters across hospital types, the distance traveled for admission, and the concentration of encounters among hospitals.

We identified 1 427 565 hospitalizations, of which 210 398 involved critical care. Over time, fewer hospitals provided pediatric inpatient or critical care, and encounters became more concentrated in specialty hospitals. Median travel distance for inpatient care rose from 4.9 miles in 2001 to 8.3 miles in 2022 (an increase of 69.4%), with CMC and children with TD traveling farthest in all years. Critical care travel distances were generally stable over time. Concentration of encounters for children without medical complexity increased more rapidly than for CMC and children with TD.

Between 2001 and 2022, regionalization most affected care for noncritical care inpatient encounters and for children without medical complexity. Care patterns for children without complexity converged with those for CMC and children with TD. These trends have important implications for family travel burden and efforts to maintain pediatric readiness outside of specialty centers.