Association Between Hospital Consolidation and Loss of Pediatric Inpatient Services

Joseph, Allan M.; Davis, Billie S.; Kahn, Jeremy M.

doi:10.1001/jamapediatrics.2023.1747

Cited by 9 publications

(1 citation statement)

References 7 publications

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“…In the absence of an established taxonomy, researchers have used a variety of approaches to classify pediatric capabilities. These have included considering freestanding children’s hospital status, 11 , 12 teaching status, 13 volume of pediatric patients, 2 , 6 structural features (such as presence of an inpatient unit or intensive care unit [ICU]), 1 , 14 , 15 and propensity to transfer. 16 However, none of these categories specifically identifies the extent of pediatric capabilities.…”

Section: Introductionmentioning

confidence: 99%

Defining Levels of US Hospitals’ Pediatric Capabilities

Michelson,

Alpern,

Remick

et al. 2024

JAMA Netw Open

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ImportanceClassifying hospitals across a wide range of pediatric capabilities, including medical, surgical, and specialty services, would improve understanding of access and outcomes.ObjectiveTo develop a classification system for hospitals’ pediatric capabilities.Design, Setting, and ParticipantsThis cross-sectional study included data from 2019 on all acute care hospitals with emergency departments in 10 US states that treated at least 1 child per day. Statistical analysis was performed from September 2023 to February 2024.ExposurePediatric hospital capability level, defined using latent class analysis. The latent class model parameters were the presence or absence of 26 functional capabilities, which ranged from performing laceration repairs to performing organ transplants. A simplified approach to categorization was derived and externally validated by comparing each hospital’s latent class model classification with its simplified classification using data from 3 additional states.Main Outcomes and MeasuresHealth care utilization and structural characteristics, including inpatient beds, pediatric intensive care unit (PICU) beds, and referral rates (proportion of patients transferred among patients unable to be discharged).ResultsUsing data from 1061 hospitals (716 metropolitan [67.5%]) with a median of 2934 pediatric ED encounters per year (IQR, 1367-5996), the latent class model revealed 4 pediatric levels, with a median confidence of hospital assignment to level of 100% (IQR, 99%-100%). Of 26 functional capabilities, level 1 hospitals had a median of 24 capabilities (IQR, 21-25), level 2 hospitals had a median of 13 (IQR, 11-15), level 3 hospitals had a median of 8 (IQR, 6-9), and level 4 hospitals had a median of 3 (IQR, 2-3). Pediatric level 1 hospitals had a median of 66 inpatient beds (IQR, 42-86), level 2 hospitals had a median of 16 (IQR, 9-22), level 3 hospitals had a median of 0 (IQR, 0-6), and level 4 hospitals had a median of 0 (IQR, 0-0) (P &lt; .001). Level 1 hospitals had a median of 19 PICU beds (IQR, 10-28), level 2 hospitals had a median of 0 (IQR, 0-5), level 3 hospitals had a median of 0 (IQR, 0-0), and level 4 hospitals had a median of 0 (IQR, 0-0) (P &lt; .001). Level 1 hospitals had a median referral rate of 1% (IQR, 1%-3%), level 2 hospitals had a median of 25% (IQR, 9%-45%), level 3 hospitals had a median of 70% (IQR, 52%-84%), and level 4 hospitals had a median of 100% (IQR, 98%-100%) (P &lt; .001).Conclusions and RelevanceIn this cross-sectional study of hospitals from 10 US states, a system to classify hospitals’ pediatric capabilities in 4 levels was developed and was associated with structural and health care utilization characteristics. This system can be used to understand and track national pediatric acute care access and outcomes.

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