The closure of pediatric inpatient units and in some cases entire children’s hospitals over the past decade has restricted the availability of services for children with medical complexity and a regionalization of service availability. This can make access difficult for families living in rural areas who may not be able to have their child’s needs met at the community hospital that is closest to them.
To get a better understanding of where children with medical complexity go for their hospital care, Moynihan et al (10.1542/peds.2022-059014), in a retrospective cross-sectional study being early released in Pediatrics this week, focused on children with technology dependence (CTD), meaning children who had a tracheostomy, gastrostomy, and/or intraventricular shunt. The authors identified 37,108 CTD encounters in 6 states over the course of a year involving 543 different hospitals in those 6 states. Most of those encounters (70% of emergency visits and 85.3% of inpatient admissions) occurred in 34 hospitals (6%) that were classified as “high capability.” Most CTD encounters occurred 4 times further away in distance than the closest facility available. CTD who are Black, publicly insured, or lived in disadvantaged neighborhoods were more likely to use their closest hospital instead of a more distant hospital that might be able to provide additional services.
To further explore these findings and understand the risk of inequities, we invited Drs. Heidi Kloster and Ryan Coller from the University of Wisconsin, specialists in CTD care, to share their thoughts in an accompanying commentary (10.1542/peds.2022-060878). They remind us that getting care at a higher capability hospital does not mean best outcome or that a lower capability hospital will not do well caring for many more common problems that CTD might have. They also raise the need to consider the potential risk of traveling further for care instead of seeking care locally.
There is much to be done to help your local community hospital be better prepared to care for CTD rather than have families travel to potentially overcrowded high capability hospitals. Link to this important article and commentary and reflect how their findings play out in your local community and how you can reduce any inequities in care that might be discovered in your region as a result.
