Development and Evaluation of Pediatric Acute Care Hospital Referral Regions in Eight States

• Published in: The Journal of pediatrics p. 114371
• Main Authors: Joseph, Allan M., Minturn, John S., Kurland, Kristen S., Davis, Billie S., Kahn, Jeremy M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 16.10.2024
• Subjects: SEDD; HCUP; HSA; HRR; AHA; IQR; ED; SID
• ISSN: 0022-3476; 1097-6833; 1097-6833
• DOI: 10.1016/j.jpeds.2024.114371

To develop a set of pediatric acute care hospital referral regions for use in studying pediatric acute care delivery, and test their utility relative to other regional systems. We used state-level administrative databases capturing all pediatric acute care in eight states to construct novel referral regions. We first constructed pediatric hospital service areas (PHSAs) based on 5,837,464 pediatric emergency department encounters. We then aggregated these PHSAs to pediatric hospital referral regions (PHRRs) based on 344,440 pediatric hospitalizations. Finally, we used three measures of spatial accuracy (localization index, market share index, and net patient flow) to compare this novel region system with the Dartmouth Atlas, designed originally to study adult specialty care, and the Pittsburgh Atlas, designed originally to study adult acute care. The development procedure resulted in 717 novel PHSAs, which were then aggregated to 55 PHRRs across the included states. Relative to HRRs in the Dartmouth and Pittsburgh Atlases, PHRRs were fewer in number and larger in area and population. PHRRs more accurately captured patterns of pediatric hospitalizations, (eg, mean localization index: 69.1 out of 100, compared with a mean of 58.1 for the Dartmouth Atlas and 62.4 for the Pittsburgh Atlas). The use of regional definitions designed specifically to study pediatric acute care better captures contemporary pediatric acute care delivery than the use of existing regional definitions. Future work should extend these definitions to all US states to enable national analyses of pediatric acute care delivery. To date, most regional analyses in health care have used definitions derived by the Dartmouth Atlas of Health Care.15 Analyses of variation in care based on the Dartmouth Atlas have provided important insight into strategies to improve care delivery in the US.16–20 However, the Dartmouth Atlas has many limitations that reduce its utility for understanding pediatric acute care. First, it was developed using 1990s Medicare claims data to study adult specialty care, with a purpose and method that bear little resemblance to contemporary patterns of pediatric acute care delivery.21 In addition, the pediatric acute care system has diverged from the adult system in recent years through closure of inpatient units and increased transfers to referral centers,5,22,23 leading to a paradigm in which pediatric emergency care is widely distributed, with over 90 percent of emergency visits in general EDs,24 while inpatient care is concentrated in an increasingly small number of primarily urban specialty hospitals.25,26