595 - Safety-Net Hospitals’ Performance in Inpatient Pediatric Care in United States

Poster Number: 595
Publication Number: 595.319

Alexandra Iacob, Miller Children's & Women's Hospital Long Beach, Long Beach, CA, United States; Emily M. Pang, Stanford University School of Medicine, San Francisco, CA, United States; Daniel Tawfik, Stanford University School of Medicine, Palo Alto, CA, United States; Jochen Profit, Stanford University School of Medicine, Palo Alto, CA, United States

Background: Safety-net (sn) hospitals provide care to a large population of uninsured or Medicaid patients as well as patients of lower socioeconomic status within the US. Prior research has highlighted disparities in care depending on the social determinants of health, including patient race/ethnicity, insurance status, and neighborhood of residence. Some studies have additionally suggested that site of care contributes to unequal care. The difference in overall performance of sn hospitals compared to non-sn hospitals remains unclear.

Objective: This study aims to provide a systematic review of the literature on the quality and performance of inpatient pediatric care in US sn hospitals compared to non-sn hospitals.

Design/Methods: Pubmed, Cumulative Index to Nursing and Allied Health Literature, and Web of Science were searched for studies published between January 2000 and January 2021, by using search queries organized around keywords related to safety-net hospitals, inpatient, and pediatric care. The study was registered with PROSPERO (CRD42021203446, 11/02/2021). Two reviewers independently screened all studies for eligibility, extracted data, and cross-checked results, with all conflicts resolved through discussion and consensus. The eligible studies were then categorized by comparison level (e.g. teaching vs non-teaching hospital, urban teaching vs urban non-teaching hospital). Information extracted focused on hospital performance, process, or structure metrics available that distinguish between sn and non-sn hospitals.

Results: A total of 7198 studies were retrieved across the three search engines. Title and abstract screening yielded 342 studies. Appraisal of the full text resulted in 50 studies selected for extraction. Of these 50 studies, 4 mentioned sn hospitals and only 3 used their sn classification in the analysis (Table 1). These 3 studies showed that sn hospitals outcomes were similar or worse than non-sn hospitals. Given the paucity of studies specifically evaluating sn hospitals, we additionally broke down the studies by other comparison levels used commonly to characterize hospitals: 14 teaching vs nonteaching, 8 urban teaching vs urban nonteaching, and 5 urban vs rural comparisons, with the remaining comparison levels including ≤ 2 studies. The studies had heterogenous population inclusions, comparison levels, and study outcomes.

Conclusion(s): This study highlights the lack of a standard definition of safety-net hospitals and the scarcity of research to date that examines pediatric safety-net hospitals and their overall performance.