P4A164: Regionalization Effects on Pediatric Hospitalizations and Transfers by Hospital Type from 2016 to 2019

Background: Regionalization of pediatric inpatient healthcare has led to a shift in demographics of where children are hospitalized, with studies showing an increase in the number of inpatient beds at freestanding children’s hospitals despite a concomitant overall decrease in pediatric inpatient beds and units nationally. Our goal was to characterize the effect of regionalization on pediatric hospitalizations and proportion of transfers in from another acute care site by hospital type.

Methods: We utilized all hospitalizations in the 2016 and 2019 Kids’ Inpatient Databases. Descriptive statistics were used to determine the proportion of discharges and transfers in from another acute care site by hospital type in each year. Proportions of discharges and transfers in by hospital type from the 2019 data were compared with 2016 using descriptive statistics and Chi square.

Results: Pediatric discharges from rural and urban non-teaching hospitals in 2019 accounted for a smaller percentage of discharges when compared with 2016, decreasing from 6.7% to 6.1% and 17.6% to 11.4% respectively (Table 1). Conversely, discharges from urban teaching and freestanding children’s hospitals accounted for a larger percentage of discharges in 2019, increasing from 62.2% to 67.7% and 13.5% to 14.8% respectively. Percent of total transfers in from another acute care hospital increased for freestanding children’s hospitals from 30.2% to 34.2%, while decreasing for all other hospital types including urban teaching hospitals (Table 2). All changes were statistically significant (p < 0.001).

Conclusion: Our analysis demonstrates a shift in the hospital types where children receive inpatient care, with an increasing number and percentage of hospitalizations at urban teaching and freestanding children’s hospitals. There was also an increase in the proportion of transfers from another acute care site that went to freestanding children’s hospitals. It is plausible that this trend has contributed to the overcrowding anecdotally seen at freestanding children’s hospitals, and that there are effects on access to healthcare and healthcare costs. There is likely an unequal impact on historically marginalized communities that will be important to study further, particularly those in rural settings at a greater distance from urban centers.