The regionalization of pediatric health care

Abstract

Regionalization of health care is a method of providing high-quality, cost-efficient health care to the largest number of patients. Within pediatric medicine, regionalization has been undertaken in 2 areas: neonatal intensive care and pediatric trauma care. The supporting literature for the regionalization of these areas demonstrates the range of studies within this field: studies of neonatal intensive care primarily compare different levels of hospitals, whereas studies of pediatric trauma care primarily compare the impact of institutionalizing a trauma system in a single geographic region. However, neither specialty has been completely regionalized, possibly because of methodologic deficiencies in the evidence base. Research with improved study designs, controlling for differences in illness severity between different hospitals; a systems approach to regionalization studies; and measurement of parental preferences will improve the understanding of the advantages and disadvantages of regionalizing pediatric medicine and will ultimately optimize the outcomes of children.

Figure 1

Various forms of regionalization systems. Squares represent central, specialty hospitals, while the triangles represent non-specialty hospitals. Arrows represent the direction of patients within the system. The spoke-and-hub system and the web system are characterized by a specialty center that manages patients referred by outlying non-specialty hospitals. The degree of coordination between the two types of hospitals distinguishes between these two systems. The mini-hub model is characterized by an expansion of specialty hospitals that have differing degrees of interaction with the transport system, non-specialty hospitals, and with other specialty hospitals. The integrated web approach is characterized by seamless communication and coordination between specialty and non-specialty hospitals.

Figure 2

Conceptual framework for the development of regional systems. Various factors contribute to the development of both the type of regionalized system described in Figure 1 and the overall degree of regionalization.