Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;
University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania;
Pediatrics. 2014 Jun;133(6):1061-9. doi: 10.1542/peds.2013-3466. Epub 2014 May 5.
The wide geographic variation in pediatric subspecialty supply in the United States has been a source of concern. Whether children in areas with decreased supply receive less subspecialty care or have worse outcomes has not been adequately evaluated. Among children with special health care needs, we examined the association between pediatric subspecialty supply and subspecialty utilization, need, child disease burden, and family disease burden.
We measured pediatric subspecialist supply as pediatric subspecialists per capita in each residential county. By using the 2009-2010 National Survey of Children With Special Health Care Needs and controlling for many potential confounders, we examined the association between quintile of pediatric subspecialty supply and parent-reported subspecialty utilization, perceived subspecialty need, and child and family disease burden.
County-level pediatric subspecialty supply ranged from a median of 0 (lowest quintile) to 59 (highest quintile) per 100 000 children. In adjusted results, compared with children in the highest quintile, children in the lowest quintile of supply were 4.8% less likely to report ambulatory subspecialty visits (P < .001), 5.3% less likely to perceive subspecialty care needs (P < .001), and 2.3% more likely to report emergency department visits (P = .018). There were no meaningful differences between pediatric subspecialty supply quintiles for other measures of child or family disease burden.
Children living in counties with the lowest supply of pediatric subspecialists had both decreased perceived need for subspecialty care and decreased utilization of subspecialists. However, the differences in supply were not associated with meaningful differences in child or family disease burden.
美国儿科专科供应在地理上的广泛差异一直令人担忧。在供应减少的地区，儿童是否接受较少的专科护理或结果更差，尚未得到充分评估。在有特殊医疗需求的儿童中，我们研究了儿科专科供应与专科利用、需求、儿童疾病负担和家庭疾病负担之间的关系。
我们以每个居住县的儿科专科医生人数来衡量儿科专科医生的供应。通过使用 2009-2010 年全国有特殊医疗需求儿童调查，并控制许多潜在的混杂因素，我们检查了儿科专科供应的五分位数与父母报告的专科利用、感知专科需求以及儿童和家庭疾病负担之间的关系。
县级儿科专科供应范围从每 10 万儿童中位数 0（最低五分位数）至 59（最高五分位数）。在调整后的结果中，与供应最高五分位的儿童相比，供应最低五分位的儿童报告门诊专科就诊的可能性低 4.8%（P <.001），感知专科护理需求的可能性低 5.3%（P <.001），而急诊就诊的可能性高 2.3%（P =.018）。在其他衡量儿童或家庭疾病负担的指标方面，儿科专科供应五分位之间没有明显差异。
生活在儿科专科医生供应最低的县的儿童，他们对专科护理的需求既减少，也减少了对专科医生的利用。然而，供应方面的差异与儿童或家庭疾病负担的显著差异无关。
