Tech-dependent pediatric patients travel greater distances for care

Key takeaways:

• Families with technology-dependent children were more likely to travel for hospital care.
• Many hospitals are unfamiliar with technology dependence, such as ventricular shunts, gastrostomy and tracheostomy.

Families caring for children with technology dependence are more likely to travel long distances for medical care, routinely bypassing closer hospitals to access facilities with more capabilities, researchers reported in Pediatrics.

Children with technology dependence (CTD) include those with ventricular shunts, gastrostomy or tracheostomy — “a subset [that] are among the most prevalent and most commonly associated with admissions,” the authors of the new study wrote.

“Although it remains unclear how often CTD access emergency departments in their communities, it is reasonable to consider them particularly vulnerable to ongoing service concentration,” they wrote.

The researchers conducted a retrospective, cross-sectional study using data from 2,017 inpatient and ED encounters for a tracheostomy, gastrostomy or vehicular shunt in Arizona, Florida, Kentucky, Massachusetts, New York and Wisconsin.

They measured the pediatric Hospital Capability Index for all hospitals within each of the six states.

In the index, 0 referred to hospitals not caring for or always transferring children, a score of up to 0.25 referred to facilities that provide limited care for a few conditions, a score between 0.25 and 0.75 covered “a range of community hospitals offering varying levels of pediatric service” and values near 1 represented referral centers that “always admit and seldom transfer children.” Institutions with a score of 0.75 or larger were referred to as “high capability” by the authors.

Among 37,108 CTD encounters, 75.7% were reported to have a gastrostomy, 24.2% a ventricular shunt and 17.3% a tracheostomy. The researchers identified 543 hospitals that had encountered at least one CTD case — 525 of them general care hospitals and 18 of them specialty or rehabilitation institutions. Of the general hospitals that had encountered such cases, only 6.3% were deemed high-capability centers.

The researchers found that 35% of hospitals had never seen a CTD. Out of all the visits, only 11.7% were deemed to be the closest facilities, and families with CTD were 10 times more likely to travel to higher capability centers. Overall, 79.7% of general hospital encounters occurred within one of 34 high-capability centers.

The researchers also found that Blacks patients, people with Medicaid and residents from disadvantaged neighborhoods were less likely to receive care at high-capability centers.

“With consolidation of pediatric care, there are fewer community hospital options and experienced care is less available,” they wrote. “Children with complex chronic conditions and their families are therefore under particular pressure to adapt.”

The study was accompanied by a commentary co-authored by Ryan J. Coller, MD, and Heidi M. Kloster, MD, both members of the department of pediatrics at the University of Wisconsin – Madison.

“Why might these patterns occur?” they wrote. “Limited opportunity for choice exists when care location is determined by hospital capacity, specialized service needs, or one’s physical location and severity at illness onset. Therefore, a major part of the answer is whether location represents an explicit decision by someone — patients, families, emergency responders, and/or health care providers. But how often hospital location reflects deliberate decision-making to use a specific location when multiple options exist is poorly understood.”

Kloster and Coller added that although the study focuses on CTD, such data could show effects on all children with health issues.

“Children with tracheostomies, gastrostomies, and ventricular shunts are a selective group with higher stakes, yet these issues affect all children at risk for serious health emergencies,” they wrote.

References:

Kloster HM, et al. Pediatrics. 2023;doi:10.1542/peds.2022-060878.

Moynihan K, et al. Pediatrics. 2023;doi:10.1542/peds.2022-059014.