502 - Experiences of Rural and Non-Rural Caregivers During Their Child’s Hospitalization

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 502
Publication Number: 502.221

Jessica Bettenhausen, Children's Mercy Kansas City, Kansas City, MO, United States; Rachel E. Granberg, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Zoetta L. McLoughlin, Children's Mercy Hospitals and Clinics, Mission, KS, United States; Laura M. Plencner, Children's Mercy Hospitals and Clinics, Prairie Village, KS, United States; Molly K. Krager, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States; Matt Hall, Children's Hospital Association, Lenexa, KS, United States; Jeffrey D. Colvin, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States

Presenting Author(s)

JB

Jess Bettenhausen, MD (she/her/hers)

Pediatric Hospitalist
Children's Mercy Kansas City
Kansas City, Missouri, United States

Background: Over 5 million rural children and their families are hospitalized each year. At Children’s Mercy – Kansas City, > 1 in 5 hospitalized children are from rural areas. Many pediatric hospitalizations are the result of poor health care access. In addition, hospitalizations cause a financial burden on the family due to missed work and other reasons. Little is known about differences in health care access and financial burden of hospitalizations for rural families compared to non-rural families.

Objective: To describe how hospitalized children from rural vs. non-rural areas differ in demographics, health care access, and financial burden of the hospitalization.

Design/Methods: This prospective cross-sectional survey enrolled a random sample of caregivers of hospitalized children between 8/31/2021 and 12/2/2022 at a single children’s hospital. We excluded patients within the ICU and children with medical complexity. We gathered demographic information and surveyed caregivers to quantify perceived access to high quality care, distance to primary care, and distance and mode of transport to the children’s hospital for hospitalization. In addition, we surveyed caregivers about financial concerns, fear of job loss, and skipped meals during hospitalization. Bivariate analyses were used to determine statistically significant differences.

Results: 170 caregivers, 47.7% from rural areas participated in the study (Table 1). A greater proportion of rural vs. non-rural caregivers were white (80.2% vs. 70.8%) and reported lower levels of income (e.g., 56.8% vs. 33.7% with income of < $50,000 per year). Rural caregivers endorsed poor health care access at higher rates than non-rural caregivers (e.g., concerns with access to high quality care: 45.7% vs. 13.5%; health care needs met in the community: 32.1% vs. 61.8%) and longer median distances to primary care (e.g., 15 miles [interquartile range (IQR) 5,30] vs. 10 miles [IQR 5,16], Table 2). Rural caregivers also reported much longer median distances to the children’s hospital (125 miles [IQR 100,175] vs. 20 miles [IQR 11,30]) with > 1 in 4 rural children arriving by air transport. Although there were no differences based upon rurality, out-of-pocket costs during hospitalization approached $400, > 1 in 4 caregivers feared job loss, and > 2 in 3 skipped meals with nearly 1 in 3 due to cost alone (Table 3).

Conclusion(s):

Rural caregivers more commonly report poor health care access, which may lead to hospitalizations. While out-of-pocket costs were similar, more hospitalizations with air transport coupled with low incomes creates a disproportionate burden for rural families.