In California, significant gains have been made since 1983 in the inpatient regionalized specialty care of pediatric congenital heart disease.
“After examining population-based data longitudinally during nearly 30 years in California, distinct patterns of regionalized care for pediatric patients with congenital heart disease have emerged,” Lisa J. Chamberlain, MD, MPH, from the department of pediatrics, division of general pediatrics, Stanford University School of Medicine, and colleagues wrote in a recent study.
Chamberlain and colleagues conducted a retrospective analysis of discharge data on 164,310 pediatric hospitalizations in California from 1983 to 2011. Seventy percent of discharges were associated with a surgical procedure and the rest were for hospitalization without surgical intervention. Most of the children were aged younger than 5 years (73%), male (55%) and non-Hispanic white (42%).
During the study period, discharges from pediatric cardiology specialty care centers, as identified based on accreditation by the California Title V program, increased from 58% in 1983 to 88% in 2011 (P < .0001). In 2011, the regionalization of pediatric cardiology specialty care was 96% for surgical cases compared with 71% for nonsurgical cases; the rates of both increased from 61% and 48%, respectively, in 1983.
From 1983 to 2011, total bed days for inpatient care increased from 35,753 to 71,278, according to the researchers. Bed days for specialty vs. nonspecialty care differed; the number of bed days was increased in pediatric cardiology specialty care centers from 22,949 in 1983 to 65,189 in 2011 and decreased in nonspecialty care centers from 12,804 in 1983 to 6,089 in 2011.
The median length of stay increased during the study period, from 2 days to 3 days for nonspecialty care and from 4 days to 5 days for specialty care.
“Accompanying the evolution of regionalized care was the change in payer status,” the researchers wrote. Overall, admissions with a public payer increased from 42% in 1983 to 61% in 2011, and admissions with a private payer decreased from 48% to 38%. In 2011, 66% of all bed days for pediatric congenital heart disease cases were covered by public programs compared with 50% in 1983; 96% of those cases were in specialty hospitals.
The most common discharge diagnosis also changed during the study period, from tetralogy of Fallot in 1983 to coarctation of the aortic in 2011.
The researchers also observed decreases in pediatric congenital heart disease mortality rates. From 1983 to 2011, the in-hospital mortality rate improved from 5.1 per 100,000 people to 2.3 per 100,000 people. There was a trend, however, toward a larger proportion of deaths occurring in the newborn period.
According to the researchers, these findings suggest that overall progress has been made in concentrating care in pediatric cardiology specialty care centers, but additional work is needed to decrease dependence on public reimbursement rates.
“With increasing survivorship and an aging congenital heart disease population, many challenges remain,” the researchers wrote. “The fragility of inpatient care dominated by public payer status requires an increasing focus on the unique epidemiology of pediatric congenital heart disease and its attendant systems of regionalized care.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.