The Costs and Benefits of Regionalized Care for Children

Abstract

Regionalization of health care, when purposefully designed, aims to improve the quality and safety of health care delivery by directing patients to facilities with optimal resources and experience for their particular health needs.1 Although strong evidence supports regionalized care for cardiac arrest and stroke, trauma, and neonatal intensive care, considerably less is known about the regionalization of care for children with common medical conditions.1,2 In this issue of Pediatrics , Cushing et al’s3 article, “Trends in Regionalization of Emergency Care for Common Pediatric Conditions,” examines national rates of admission, interhospital transfer, and referral for children with gastroenteritis, asthma, and croup. Analyzing the Nationwide Emergency Department Sample from 2008 to 2016, Cushing et al3 found decreasing rates of admission at the hospitals where children presented for care, a slight increase (0.3%) in transfers for asthma, and unchanged transfer rates for croup and gastroenteritis. However, they identified significant increases in interhospital referral rates, which they defined as the number of children with each condition who were transferred to another hospital divided by the total number of children who were admitted or transferred. The authors use this outcome as an indicator of referral for “definitive … Address correspondence to JoAnna Leyenaar, MD, PhD, MPH, Department of Pediatrics, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756. E-mail: joanna.k.leyenaar{at}hitchcock.org