Abstract
The availability of pediatric hospital care for common conditions is decreasing across the US. The consequences of this decrease on access to care for specific conditions need to be evaluated. To evaluate the degree of regionalization of pediatric seizure care in the US by characterizing the activity of hospital systems in 6 diverse states. This retrospective cross-sectional study used inpatient and emergency department administrative data sets from all acute care hospitals in Arkansas, Florida, Kentucky, Maryland, Massachusetts, and New York from 2014. All patients younger than 18 years who visited a hospital and had a primary diagnosis of seizures were included. Data were analyzed between January and June 2019. Characteristics of hospital encounters and pediatric Hospital Capability Index scores of transferring and admitting hospitals. Among 57 930 encounters with pediatric patients with seizures (median [range] age, 4 [1-11] years; 31 968 [55.2%] boys) identified in 621 acute care hospitals, 15 467 patients (26.7%) were admitted as inpatients and 3748 patients (6.5%) were transferred between acute care hospitals. Among encounters that resulted in transfers between hospitals, seizure was the only diagnosis in 1554 patients (41.5%). A total of 42 463 encounters began as emergency department visits, of which 38 173 encounters (90.0%) resulted in routine discharge. While 536 hospitals (86.3%) transferred children with seizures, only 232 hospitals (37.4%) ever admitted them and only 63 hospitals (10.1%) ever received a pediatric seizure transfer. The median (interquartile range) pediatric Hospital Capability Index score of all hospitals was 0.10 (0.02-0.28), while that of hospitals occasionally admitting pediatric seizure patients was 0.34 (0.22-0.55). However, although most patients who were admitted had brief stays (ie, ≤2 days) and no comorbidities, three-quarters of all admissions (12 002 admissions [77.6%]) were to very highly capable centers (ie, hospitals with pediatric Hospital Capability Index scores >0.75). Across all states, the number of referral hospitals for pediatric seizures was less than the number of Dartmouth Atlas Hospital Referral Regions (47 referral hospitals vs 63 hospital referral regions). These findings suggest that although children with seizures are seen in almost all acute care hospital emergency departments, most hospitals transfer children who require admission. Condition-specific interhospital dependency challenges standard definitions of network adequacy and should be accounted for in emergency medical service planning, access to care policies, and health services research.
Highlights
Pediatric hospital care is consolidating throughout the US, and its availability is decreasing even for common conditions.[1]
The number of referral hospitals for pediatric seizures was less than the number of Dartmouth Atlas Hospital Referral Regions (47 referral hospitals vs 63 hospital referral regions)
These findings suggest that children with seizures are seen in almost all acute care hospital emergency departments, most hospitals transfer children who require admission
Summary
Pediatric hospital care is consolidating throughout the US, and its availability is decreasing even for common conditions.[1] This has important implications for access to care, disaster management, and determination of network adequacy As part of this process, an informal network of interhospital transfer has arisen to compensate for the diminishing capabilities of individual institutions.[2] little is known about the structure, nature, and condition-specific functioning of these networks. In response to increasing financial pressure, many insurers seek to control their costs through the creation of care networks Under these arrangements, health care systems are included within networks when they agree on compensation rates and are excluded when they do not. As fewer practitioners accept lower rates, networks narrow and risk exclusion of services, services for children.[3,4] Regulatory oversight of this process is shared by state and federal agencies, but present quantitative standards for network adequacy are limited for adults and inapplicable to children.[5]
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