From the Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School Boston, MA.
Pediatr Emerg Care. 2023 Nov 1;39(11):817-820. doi: 10.1097/PEC.0000000000002820. Epub 2022 Sep 11.
Pediatric hospital care is becoming increasingly regionalized, and previous data have suggested that insurance may be associated with transfer. The aims of the study are to describe regionalization of pediatric care and density of the interhospital transfer network and to determine whether these varied by insurance status.
Using the New York State ED Database and State Inpatient Database from 2016, we identified all pediatric patients and calculated regionalization indices (RI) and network density, overall and stratified by insurance. Regionalization indices are based on the likelihood of a patient completing care at the initial hospital. Network density is the proportion of actual transfers compared with the number of potential hospital transfer connections. Both were calculated using the standard State ED Database/State Inpatient Database transfer definition and in a sensitivity analysis, excluding the disposition code requirement.
We identified 1,595,566 pediatric visits (emergency department [ED] or inpatient) in New York in 2016; 7548 (0.5%) were transferred and 7374 transferred visits had eligible insurance status (Medicaid, private, uninsured). Of the transfers, 24% were from ED to ED with discharge, 28% from ED to ED with admission, 31% from ED to inpatient, 16% from inpatient to inpatient, and 1.2% from inpatient to ED. The overall RI was 0.25 (95% confidence interval [95% CI], 0.20-0.31). The overall weighted RI was 0.09 (95% CI, 0.06-0.12) and was 0.09 (95% CI, 0.06-0.13) for Medicaid-insured patients, 0.08 (95% CI, 0.05-0.11) for privately insured patients, and 0.08 (95% CI, 0.05-0.11) for patients without insurance. The overall network density was 0.018 (95% CI, 0.017-0.020). Network density was higher, and transfer rates were lower, for patients with Medicaid insurance as compared with private insurance.
We found significant regionalization of pediatric emergency care. Although there was not material variation by insurance in regionalization, there was variation in network density and transfer rates. Additional work is needed to understand factors affecting transfer decisions and how these patterns might vary by state.
儿科医院护理的区域化程度越来越高，先前的数据表明保险可能与转院有关。本研究旨在描述儿科护理的区域化情况和医院间转院网络的密度，并确定这些情况是否因保险状况而异。
使用 2016 年纽约州急诊数据库和州住院数据库，我们确定了所有儿科患者，并计算了整体和按保险状况分层的区域化指数（RI）和网络密度。RI 基于患者在初始医院完成治疗的可能性。网络密度是实际转院数与潜在转院连接数之比。这两者都是使用标准的州急诊数据库/州住院数据库转院定义计算的，并在敏感性分析中，排除了处置代码要求。
我们在 2016 年确定了 1595566 例纽约儿科就诊（急诊或住院），其中 7548 例（0.5%）转院，7374 例转院有合格的保险状况（医疗补助、私人、无保险）。在转院中，24%是从急诊到急诊出院，28%是从急诊到急诊入院，31%是从急诊到住院，16%是从住院到住院，1.2%是从住院到急诊。总体 RI 为 0.25（95%置信区间[95%CI]，0.20-0.31）。总体加权 RI 为 0.09（95%CI，0.06-0.12），医疗补助保险患者为 0.09（95%CI，0.06-0.13），私人保险患者为 0.08（95%CI，0.05-0.11），无保险患者为 0.08（95%CI，0.05-0.11）。总体网络密度为 0.018（95%CI，0.017-0.020）。与私人保险相比，医疗补助保险患者的网络密度更高，转院率更低。
我们发现儿科急诊护理存在显著的区域化。尽管保险对区域化没有实质性影响，但网络密度和转院率存在差异。需要进一步研究以了解影响转院决策的因素以及这些模式如何因州而异。
