Department of Pediatrics, Dartmouth Health Children's, Lebanon, New Hampshire.
The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
JAMA Netw Open. 2023 Sep 5;6(9):e2331807. doi: 10.1001/jamanetworkopen.2023.31807.
National analyses suggest that approximately 1 in 5 US hospitals closed their pediatric units between 2008 and 2018. The extent to which pediatric hospitalizations at general hospitals in rural and urban communities decreased during this period is not well understood.
To describe changes in the number and proportion of pediatric hospitalizations and costs at urban teaching, urban nonteaching, and rural hospitals vs freestanding children's hospitals from 2009 to 2019; to estimate the number and proportion of hospitals providing inpatient pediatric care; and to characterize changes in clinical complexity.
DESIGN, SETTING, AND PARTICIPANTS: This study is a retrospective cross-sectional analysis of the 2009, 2012, 2016, and 2019 Kids' Inpatient Database, a nationally representative data set of US pediatric hospitalizations among children younger than 18 years. Data were analyzed from February to June 2023.
Pediatric hospitalizations were grouped as birth or nonbirth hospitalizations. Hospitals were categorized as freestanding children's hospitals or as rural, urban nonteaching, or urban teaching general hospitals.
The primary outcomes were annual number and proportion of birth and nonbirth hospitalizations and health care costs, changes in the proportion of hospitalizations with complex diagnoses, and estimated number and proportion of hospitals providing pediatric care and associated hospital volumes. Regression analyses were used to compare health care utilization in 2019 vs that in 2009.
The data included 23.2 million (95% CI, 22.7-23.6 million) weighted hospitalizations. From 2009 to 2019, estimated national annual pediatric hospitalizations decreased from 6 425 858 to 5 297 882, as birth hospitalizations decreased by 10.6% (95% CI, 6.1%-15.1%) and nonbirth hospitalizations decreased by 28.9% (95% CI, 21.3%-36.5%). Concurrently, hospitalizations with complex chronic disease diagnoses increased by 45.5% (95% CI, 34.6%-56.4%), and hospitalizations with mental health diagnoses increased by 78.0% (95% CI, 61.6%-94.4%). During this period, the most substantial decreases were in nonbirth hospitalizations at rural hospitals (4-fold decrease from 229 263 to 62 729) and urban nonteaching hospitals (6-fold decrease from 581 320 to 92 118). In 2019, birth hospitalizations occurred at 2666 hospitals. Nonbirth pediatric hospitalizations occurred at 3507 hospitals, including 1256 rural hospitals and 843 urban nonteaching hospitals where the median nonbirth hospitalization volumes were fewer than 25 per year.
Between 2009 and 2019, the largest decreases in pediatric hospitalizations occurred at rural and urban nonteaching hospitals. Clinical and policy initiatives to support hospitals with low pediatric volumes may be needed to maintain hospital access and pediatric readiness, particularly in rural communities.
国家分析表明，2008 年至 2018 年间，美国约有五分之一的医院关闭了儿科病房。在此期间，农村和城市社区的综合医院的儿科住院人数减少了多少，目前还不太清楚。
描述 2009 年至 2019 年期间，城市教学医院、城市非教学医院和农村医院与独立儿童医院相比，儿科住院人数和住院费用的数量和比例的变化；估计提供住院儿科护理的医院数量和比例；并描述临床复杂性的变化。
设计、地点和参与者：这是一项回顾性的横断面分析，研究对象是 2009 年、2012 年、2016 年和 2019 年儿童住院数据库（美国儿童住院数据库）中的数据，该数据库是全美儿童 18 岁以下住院数据的代表性数据集。数据分析于 2023 年 2 月至 6 月进行。
儿科住院患者分为出生或非出生住院患者。医院分为独立儿童医院和农村、城市非教学和城市教学综合医院。
主要结果是每年出生和非出生住院人数和医疗费用的比例、复杂诊断住院比例的变化，以及提供儿科护理的医院数量和比例及其相关医院数量的估计。回归分析用于比较 2019 年和 2009 年的医疗保健利用情况。
数据包括 2320 万（95%CI，2270 万-2360 万）加权住院患者。从 2009 年到 2019 年，估计全国儿科住院人数从 6425858 例减少到 5297882 例，其中出生住院减少了 10.6%（95%CI，6.1%-15.1%），非出生住院减少了 28.9%（95%CI，21.3%-36.5%）。与此同时，患有复杂慢性疾病诊断的住院人数增加了 45.5%（95%CI，34.6%-56.4%），患有精神健康诊断的住院人数增加了 78.0%（95%CI，61.6%-94.4%）。在此期间，降幅最大的是农村医院的非出生住院人数（从 229263 例降至 62729 例，降幅达 4 倍）和城市非教学医院的非出生住院人数（从 581320 例降至 92118 例，降幅达 6 倍）。2019 年，有 2666 家医院有出生住院。非出生儿科住院发生在 3507 家医院，其中包括 1256 家农村医院和 843 家城市非教学医院，这些医院的非出生住院人数中位数每年不到 25 人。
2009 年至 2019 年间，儿科住院人数的最大降幅发生在农村和城市非教学医院。为维持医院服务量和儿科准备能力，可能需要为低儿科服务量的医院提供临床和政策支持，特别是在农村社区。
