US hospitals see large decline in pediatric hospitalizations
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Key takeaways:
- Inpatient pediatric hospital stays fell by over one million from 2009 to 2019.
- Rural and urban nonteaching hospitals experienced the largest decreases.
Annual pediatric hospitalizations decreased substantially in the United States during a recent 10-year span, with the largest decreases seen at rural and urban nonteaching hospitals, according to a study published in JAMA Network Open.
“Over the last several years, we've heard a lot about increasing numbers of both rural and urban hospitals that have permanently closed their pediatric units, raising concerns about the implications of these closures on access to hospital care for children,” JoAnna K. Leyenaar, MD, PhD, MPH, a pediatrician at Dartmouth Health Children’s Hospital in Lebanon, New Hampshire, told Healio.
“We conducted this research to understand, on a national level, how patterns of hospital care for children have changed over the last 10 years, and to spark conversation about what these changes mean for child health and health care quality,” Leyenaar said.
Leyenaar and colleagues analyzed data from the 2009, 2012, 2016 and 2019 editions of the Kids’ Inpatient Database, which tracks U.S. pediatric hospitalizations.
“First, we looked at how hospitalizations have changed over time in terms of where children are being hospitalized, how often, and with what diagnoses,” Leyenaar said. “Second, we looked at the total number of hospitals that cared for children during the study period.”
The analysis produced an estimated 23.2 million inpatient pediatric hospitalizations from 2009 to 2019. The researchers found that the total number of inpatient pediatric hospital stays decreased significantly during that time, from an estimated 6,425,858 in 2009 to 5,297,882 in 2019.
Notably, birth hospitalizations decreased by 10.6% and nonbirth hospitalizations decreased by 28.9%.
“At the same time, hospitalizations in children have become more complex,” Leyenaar said.
They also found that hospitalizations with complex chronic disease diagnoses increased by 45.5% and hospitalizations with mental health diagnoses increased by 78%.
Leyenaar noted that although the number of hospitalizations at freestanding children's hospitals stayed relatively stable, hospitalizations at rural hospitals and urban nonteaching hospitals decreased substantially, including a fourfold decrease in nonbirth hospitalizations at rural hospitals and a sixfold decrease in nonbirth hospitalizations at urban teaching hospitals.
“The reasons that hospitals stop admitting children are complex, but in the United States, these decisions often include financial factors,” Leyenaar said. “Oftentimes, hospitalizing children is not as profitable as hospitalizing adults. This is a very important health equity issue, and one that is often overlooked by hospitals, health systems, payers, and government. Our goal for this study is to provide data to inform equitable health care policies that support child health.”
She is interested to see if things have changed since the COVID-19 pandemic.
“This is an important area of future study,” Leyenaar said. “We also need additional studies focused on the costs — both direct and indirect — of pediatric unit closures and of decreasing numbers of pediatric hospitalizations, particularly at rural hospitals. How do these hospitals maintain their capacities to provide care for children when emergencies such as natural disasters or trauma occur, and how can we ensure that children who present to these hospitals receive high-quality care? Our hope is that our work sets the stage for future studies to address these questions.”
In an editorial, Sanjay Mahant, MD, MSc, and Astrid Guttmann, MDCM, MSc, researchers in the department of pediatrics at the Hospital for Sick Children in Toronto, wrote that “the increasing regionalization of pediatric inpatient units in the U.S., as reported by Leyenaar and colleagues, has largely occurred in an uncoordinated fashion.”
“Market forces, hospital financial pressures, and the overall decline in pediatric admissions have made the viability of small pediatric units in the community and rural areas tenuous, with the major focus on adult services,” they wrote.
“Low reimbursement for pediatric admissions, seasonal variability in the pediatric unit census, and difficulties sustaining important pediatric ancillary hospital services and retaining pediatric health care professionals important for providing multidisciplinary care have all been contributing factors. Consolidation of hospitals in a region may also lead to pediatric unit closures.”
The closures “may also result in pediatric specialists pulling their outpatient services from a community, further compounding the lack of access to pediatric care,” Guttman and Mahant continued.
They suggested that telehealth and technology be used to support care locally and reduce the need for hospitalization, as well as other improvements such as interhospital transfer standards, collaborations between general and children’s hospitals to support high-quality care, and supporting the social and economic needs of displaced children and families moving between hospitals.
“Addressing the financial shortcomings and market forces underlying rural hospital and pediatric unit closures is challenging,” they wrote.
References:
- Leyenaar JK, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.31807.
- Mahant S, et al. JAMA Netw Open. 2023;doi: 10.1001/jamanetworkopen.2023.31763.
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