Department of Pediatrics, Stanford University School of Medicine, 770 Welch Rd. 100, Palo Alto, CA 94304, USA.
Pediatrics. 2010 Jun;125(6):1190-9. doi: 10.1542/peds.2009-1109. Epub 2010 May 3.
Despite the documented utility of regionalized systems of pediatric specialty care, little is known about the actual use of such systems in total populations of chronically ill children. The objective of this study was to evaluate variations and trends in regional patterns of specialty care hospitalization for children with chronic illness in California.
Using California's Office of Statewide Health Planning and Development unmasked discharge data set between 1999 and 2007, we performed a retrospective, total-population analysis of variations in specialty care hospitalization for children with chronic illness in California. The main outcome measure was the use of pediatric specialty care centers for hospitalization of children with a chronic condition in California.
Analysis of 2 170 102 pediatric discharges revealed that 41% had a chronic condition, and 44% of these were discharged from specialty care centers. Specialty care hospitalization varied by county and type of condition. Multivariate analyses associated increased specialty care center use with public insurance and high pediatric specialty care bed supply. Decreased use of regionalized care was seen for adolescent patients, black, non-Hispanic children, and children who resided in zip codes of low income or were located farther from a regional center of care.
Significant variation exists in specialty care hospitalization among chronically ill children in California. These findings suggest a need for greater scrutiny of clinical practices and child health policies that shape patterns of hospitalization of children with serious chronic disease.
尽管有文件记录表明儿科专科医疗区域化系统的实用性，但对于此类系统在慢性病儿童的全部人群中的实际应用情况却知之甚少。本研究的目的是评估加利福尼亚州慢性病儿童专科医疗住院治疗的区域模式的变化和趋势。
利用加利福尼亚州全州卫生规划与发展办公室（Office of Statewide Health Planning and Development）的未加掩饰的出院数据（1999 年至 2007 年），我们对加利福尼亚州慢性病儿童专科医疗住院治疗的区域模式变化进行了回顾性的全人群分析。主要观察指标是加利福尼亚州慢性病儿童住院治疗时使用儿科专科医疗中心的情况。
对 2170102 例儿科出院患者的分析显示，41%的患者患有慢性病，其中 44%的患者从专科医疗中心出院。专科医疗住院治疗因县和疾病类型而异。多变量分析显示，使用专科医疗中心与公共保险和高儿科专科医疗床位供应相关。在青少年患者、非裔美国儿童、居住在低收入邮政编码地区或距离专科医疗中心较远的儿童中，区域化医疗的使用减少。
在加利福尼亚州患有慢性病的儿童中，专科医疗住院治疗存在显著差异。这些发现表明，需要更严格地审查影响严重慢性疾病儿童住院治疗模式的临床实践和儿童健康政策。
