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Distance to Definitive Care: How Far is Too Far? :

October 30, 2020

How long do children have to drive to get the care they need?

How long do children have to drive to get the care they need? It’s a good question – and given where you live, the answer can vary substantially. In this month’s Pediatrics, (10.1542/peds.2020-1724) Chien et al present a study involving 70 million children nationally to determine how many live within 1 hour of pediatric services including NICU, PICU, ED, and inpatient care. It turns out, that many kids do not. As the authors note, “it may be sobering to realize that the need to drive more than one-hour in order to reach hospital-based pediatric services is more the rule than the exception.”

In some situations, waiting an hour to arrive for care might be ok. But for children with critical illnesses, an hour could mean the difference between life and death. Additionally, the increased strain on families to travel farther with a sick child, potentially have to leave other children at home and travel back and forth, is augmented by the distance. Chien et al present a current snapshot and some great maps to demonstrate the large areas of our country that lack local care. What they don’t have is data on how many rural hospitals and community hospitals are struggling to survive, and as a result, may not be able to offer the services that children can access closer to home. Prior research has shown that that nationally 3953 pediatric beds closed in small and medium sized hospitals between 2002 and 20121 which significantly reduces the chance of a child receiving pediatric care in their local community. It is likely that the current COVID-19 pandemic may further strain the financial viability of rural hospitals which could lead to even more pediatric unit closures.

If we all agree that caring for children with high quality care near home is a priority (which I would say it should be), it is going to take some creative solutions to do so. Technology like telemedicine, alternative payment models to support pediatric care in rural settings, and regional coordination between children’s hospitals and rural hospitals are some possible solutions to providing care in rural communities. But unless our country decides to invest in a child-centric care delivery system, it’s possible the distance children travel for care is likely to increase over the next decade.


  1. Khare M and Rauch DA. Trends in National Pediatric Bed Census. Pediatrics. September 2017, VOLUME 140 / ISSUE 1 Meeting Abstract.
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