Increased Utilization of Pediatric Specialty Care

Abstract

Inpatient pediatric oncology care in California has become increasingly regionalized with the vast majority of patients accessing PCSCs. However, variability in hospitalizations of adolescent patients and children not treated in PCSCs deserve further evaluation.

Examining the Effect of Travel Distance to Pediatric Cancer Centers and Rurality on Survival and Treatment Experiences: A Systematic Review

“…Common exclusion reasons included a focus primarily on young adults, no analysis of distance, or an incorrect outcome or study design. Of the included studies, 20 were retrospective cohort studies, [28][29][30][31][32]34,35,38,39,[41][42][43][44][45][46][47][48][49][50][51] 2 were prospective cohort studies, 33,40 1 was cross-sectional, 36 and 1 was a casecontrol study. 37 Given the retrospective nature of the majority of included studies, most did not report follow-up times for survival, though analyses spanned time periods from 1 32 to 30 years.…”

“…However, specific cancers analyzed included central nervous system tumors, 30,36,49 noncentral nervous system solid tumors, 31,36,46 leukemias, 33,36,38,45 medulloblastoma, 41,43 retinoblastoma, 34 and melanoma. 39 Methods used to measure distance varied significantly, including use of the Great Circles Algorithm, 28,42,46 distance between midpoints of home address and treating facility, 29,32,48 and road driving distance using either ArcGIS or Google Maps. 30,31,39,45,49 The distance traveled was categorized variably and ranged from 0 to 5 miles 29 to 300+ miles.…”

“…[34][35][36]38,41,43,45,46,51 Four studies included analysis of adults or young adults but also included appropriate subset analysis for children and/or adolescents. 28,32,35,49 Most studies were rated as good, with those receiving fair or poor ratings due largely to lack of appropriate multivariate adjustment for possible confounding factors such as socioeconomic status, race, insurance status, and location 35,37,38,41,47,50 (Table 1).…”

“…A total of 9 studies examined outcomes related to location of care or receipt of advanced therapies, specifically including the likelihood of receiving care at specialized pediatric cancer centers 28,29,32,49,50 or the likelihood of receiving proton beam therapy (PBT) or hematopoietic stem cell transplantation (HSCT) 41,42,46,48 (Table 3). Regarding treatment location, 1 study found travel distance > 40 miles was associated with the lowest odds of receiving care at specialized pediatric cancer centers compared with those living within a 0 to 5 mile radius (reference group), while those living within a 6 to 20 mile radius of these centers had the highest odds.…”

Mental Illness Drives Hospitalizations for Detained California Youth

“…First, the reliance on a large administrative database such as the OSHPD discharge dataset does not provide detailed clinical information that would allow greater definition of the psychosocial, behavioral, and management attributes associated with hospitalizations among detained youth. However, this dataset has been used successfully in analyzing hospitalization patterns for a variety of population groups 14,16,39,40 and provides important insights into the special characteristics of hospitalizations among a large population of detained youth. Second, while many of our findings were associated with very large effects sizes, some were relatively small and may have reached statistical significance because of our large sample size.…”