Trends in Transfers to Children's Hospitals

Background:

Access to care is a critical issue for child health. Although most of the focus on access is availability of primary care, the availability of hospital care for children is an underappreciated issue. Data from various sources indicate that the national pediatric bed census is falling, with losses in particular from general hospitals. HCUP Kids’ Inpatient Database (KID) shows a national increase in discharges and length of stay from 1997 to 2006, creating an increased need for beds. This trend coincides with efforts to regionalize or centralize pediatric care at children's hospitals (CHs). A marker of the increased pressure for pediatric beds may be the incidence of transfers as a source of admission to CHs. Our objective was to utilize KID to examine trends in transfers as a source of admission to CHs from 1997 to 2006.

Methods:

We examined the KID, a national data set available through the Agency for Healthcare Research and Quality from 1997 to 2006 via HCUPnet. KID data are triennial. We looked at total discharges and specifically the top 25 ICD‐9 codes in 2006, excluding newborn diagnoses, for discharge volume and source of admission as a total number and percentage of discharges for trends over time.

Results:

From 1997 to 2006, the total percentage of all pediatric discharges from CHs remained stable, at about 24%, but the percentage of transfers to CHs rose from 6.19% to 8.90%. Transfer volume and percentage were higher for ages 0–4 than for older children, even without NICU transfers. For 14 of 15 of the 2006 top‐volume ICD‐9 codes that were similar in 1997 and 2006, the percentage of admissions from transfers to CHs has risen over time. This was true whether the total number of discharges rose or fell.

Conclusions:

From 1997 to 2006, transfers to CHs have risen. The KID does not provide acuity, so it may be that hospitalized children have become sicker over the study period and the percentage of children requiring more specialized care has risen. It may also reflect a declining capacity to care for sick children in the non‐CH setting, possibly from lack of bed space. Continuation of this trend will require an increase in CH beds.

Disclosures:

D. Rauch ‐ Baxter, consultant