Background:

Health care reform has had a focus on access to care. For pediatrics this usually means access to ambulatory services. Hospitalization is an uncommon pediatric event but access to pediatric beds may be a growing issue. Surveys by the AAP and AHA indicate a loss of community hospital pediatric units and crowding at children’s hospitals. Reducing hospital payments may further pressure pediatric bed availability. There is a lack of data about trends in national pediatric hospitalizations by hospital type which could have important implications for pediatric access to care. Our objective was to examine trends in national pediatric hospitalizations for variations by hospital type.

Methods:

The AHRQ KID database via HCUPnet was reviewed for all pediatric discharges from 2000–2009. Overall volume and non–newborn volume was examined based on hospital size and children’s hospital status. Results were analyzed for trends and statistical significance.

Results:

Total discharges, newborn discharges, and non–newborn discharges were relatively stable from 2000–09 (1–3% change). Discharges decreased from small (19%) and medium hospitals (14%) and non–children’s hospitals (11%), and increased in large hospitals (3%) and children’s hospitals (12%). This pattern was more prominent for non–newborn discharges (see table). Discharges from small, medium and non–children’s hospitals are decreasing at a faster rate than the increase in discharges from large and children’s hospitals.

Conclusions:

The data shows a dramatic shift in all pediatric hospitalizations from smaller to larger hospitals and increased volume at children’s hospitals. This is consistent with previous data suggesting a loss of pediatric beds in smaller, community hospitals. This may also reflect loss of delivery services at smaller hospitals. The trend was more significant for non–newborn discharges. Access to large hospitals and children’s hospitals and ‘regionalization’ of care are potential quality issues that should be monitored.

Table 1Non–newborn discharges: total number (% of total)

Year: Hospital type 2000 2003 2006 2009 % change
Small 349,498 (15.97) 342,363(15.41) 299,569 (14.04) 224,607 (11.55) dec 36%
Medium 638,898 (29.19) 641,501 (28.87) 576,339 (27.01) 482,022 (24.79) dec 25%
Large 1,200,075 (54.84) 1,238,423 (55.73) 1,257,566 (58.94) 1,237,564 (63.65) inc 3%
Total 2,188,471 2,222,287 2,133,473 1,944,193  
Children’s Hosp 815,015 (38.42) 861,453 (40.06) 971,847 (48.08) 929,427 (49.34) inc 14%
Non–children’s 1,306,280 (61.58) 1,289,083 (59.94) 1,049,408 (51.92) 954,300 (50.66) dec 27%
Total 2,121,294 2,150,536 2,021,255 1,883,727  
(totals differ due to missing data)