Children living in rural areas admitted to children’s hospitals had more complex medical issues, resulting in more frequent readmissions and more expensive hospitalizations than children in nonrural areas, according to recent research in Pediatrics.
“Rural children hospitalized at children’s hospitals have high rates of medical complexity and often reside in low-income and medically underserved areas,” Alon Peltz, MD, MBA, of the department of pediatrics at Boston Medical Center, and colleagues wrote. “Compared with nonrural children, rural children experience more expensive hospitalizations and more frequent readmissions.”
The researchers retrospectively examined 672,190 admissions at 41 children’s hospitals for 2012 using the Pediatric Health Information System database. ZIP codes were used to identify patients as living rurally and to determine associated family median income. Statistical analysis identified differences in the characteristics of hospitalization between rural and nonrural patients.
Study data indicated rural children constituted 12% of all children’s hospital admissions. The researchers said rural children lived farther from hospitals (median, 68 miles vs. 12 miles) and more often lived in lower-income areas (52.8% vs. 24.4%) than nonrural children (P <.001).
Children living rurally more often had complex chronic conditions, with a 44% prevalence, compared with 36.7% of children living in nonrural areas (P < .001). Children in rural areas also incurred higher average inpatient costs ($8,507 vs. $7,814; P <.001), and they had a greater risk for readmission within 30 days (12.9% vs. 11.5%) than nonrural children (P < .001).
“Federal legislation is gaining support in the U.S. Congress to create optional regional networks (across state lines) that will better serve children with medical complexity, especially those in rural areas who rely on children’s hospitals for their specialty and hospital care,” Peltz and colleagues wrote. “It is hoped that these care networks will have an impact on integrating tertiary care with primary and community care for rural children.”
In an accompanying editorial, David C. Grossman, MD, MPH, professor in the health services department at the University of Washington, endorsed Peltz and colleagues for researching an understudied issue and identified some further questions for future research to address.
“This article confirms some filtering of patients from rural areas, but doesn’t tell us about those who didn’t arrive at the freestanding children’s hospitals,” Grossman wrote. “Were too few or too many children referred? What is the role of the rural critical access hospital? How can telemedicine be used to improve care in the community?
“In short, can we better organize, and evaluate, our pediatric hospital care system to improve outcomes, reduce waste, and improve the patient experience for rural children in the United States? This is a job not only for freestanding children’s hospitals, or just children’s hospitals, but our entire health system.” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.