Ongoing Trends in Pediatric Hospitalizations
Purpose: Surveys indicate a loss of community hospital pediatric units and crowding of pediatric beds at larger hospitals. Shifts in hospitalizations towards larger hospitals may impact health care costs and pressure pediatric bed space availability, ultimately affecting pediatric access to care. Using data through 2009, our team previously confirmed the shift in pediatric hospitalizations from smaller to larger hospitals. It is unclear if this trend has continued. The objective of this study is to update our previous evaluation of trends in national pediatric hospitalizations for variations in hospital size using recent data.
Methods: A retrospective observational study of pediatric hospitalizations from 2000 – 2012 using the Agency for Healthcare Research and Quality Kids' Inpatient Database (KID) via the Healthcare Cost and Utilization Project (HCUP). Discharges were stratified hospitals by size (small, medium and large).
Results: Total pediatric discharges, newborn discharges and non-newborn discharges reported in the database decreased over the 12 year period (by 8%, 4% and 14% respectively). The percentage of pediatric discharges from small and medium hospitals decreased while the percentage of pediatric discharges from large hospitals increased over the study period. This change was most pronounced for non-newborn pediatric discharges, which decreased by 34% at small hospitals, decreased by 22% at medium hospitals, and increased by 21% at larger hospitals.
Conclusion: Trends indicating decreased pediatric discharges from small and medium sized hospitals may impact pediatric access to care; this is a potential quality issue that requires additional research. The trends exhibited may reflect a loss of delivery services at smaller hospitals. Increased discharges from larger hospitals may lead to overcrowding that can cause increased safety, efficiency and quality issues. There is a lack of quality data about national pediatric hospitalizations by hospital type, which could have important implications for pediatric healthcare.