510 - Trends in Distance Traveled for Hospitalization for Rural-Residing Children from 2002 to 2017
Saturday, April 29, 2023
3:30 PM – 6:00 PM ET
Poster Number: 510 Publication Number: 510.221
Corrie E. McDaniel, University of Washington, Seattle, WA, United States; Matt Hall, Children's Hospital Association, Lenexa, KS, United States; Jay Berry, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
Assistant Professor University of Washington Seattle, Washington, United States
Background: The closure of pediatric units within community hospitals has led to a regionalization of inpatient pediatric care within children’s hospitals. Since children’s hospitals are in urban areas, these closures may disproportionately impact access to inpatient care for children in rural locations. Hospitalization farther from a child’s home has implications for quality and timeliness of care, caregiver financial burden, and public health policy. Objective: To describe distance patterns over time for definitive hospitalization for rural-residing children. Design/Methods: Using the Healthcare Cost and Utilization Project’s State Inpatient Databases, we assessed hospitalizations for children 0-17 years of age within Arizona, Colorado, Florida, Iowa, Nebraska, North Carolina, New Jersey, New York, Oregon, Rhode Island, Utah, and Washington in three-year intervals from 2002-2017. We excluded birth hospitalizations, principal mental health diagnoses, and children requiring surgical procedures as these conditions are already regionalized for care. Rurality was defined by Rural-Urban Commuting Area Codes. Outcomes included hospitalization, interfacility transfers (IFT), and concordance of patient rurality with location of hospitalization. We also compared 10 common pediatric diagnoses for distance traveled for definitive hospitalization from 2002 to 2017. Results: There were 256,947 hospitalizations for rural-residing children included. Total hospitalizations decreased from 56,168 in 2002 to 26,548 in 2017, while children requiring IFT for definitive hospitalization increased from 7% to 27% (Table 1). Rural-residing children hospitalized in a metropolitan area increased from 32% in 2002 to 73% in 2017 (p< .001) and concordance of rurality with location of hospitalization decreased from 54% to 22% (p< .001) (Figure 1). For common conditions, distance traveled for hospitalization increased by 17.7 miles (Interquartile range (IQR) 16.3, 19.2) for bronchiolitis from 2002 to 2017, 23.8 miles (IQR 21.1, 26.5) for infectious gastroenteritis, and 27.7 miles (IQR 24.5, 30.9) for diabetes (Table 2).
Conclusion(s): Fewer than half the number of rural-residing children were hospitalized in 2017 compared to 2002, yet proportionately more children required IFT and were hospitalized at distances farther from their home location. Decreasing numbers of hospitalizations may reflect a lack of access to care. Policy incentivizing and enabling sustainability for the provision of general pediatric care within rural areas may help to address these trends.
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