Availability of Pediatric Inpatient Services in the United States

Abstract

Objectives: We sought to evaluate trends in pediatric inpatient unit capacity and access and to measure pediatric inpatient unit closures across the United States.

Methods: We performed a retrospective study of 4720 US hospitals using the 2008-2018 American Hospital Association survey. We used linear regression to describe trends in pediatric inpatient unit and PICU capacity. We compared trends in pediatric inpatient days and bed counts by state. We examined changes in access to care by calculating distance to the nearest pediatric inpatient services by census block group. We analyzed hospital characteristics associated with pediatric inpatient unit closure in a survival model.

Results: Pediatric inpatient units decreased by 19.1% (34 units per year; 95% confidence interval [CI] 31 to 37), and pediatric inpatient unit beds decreased by 11.8% (407 beds per year; 95% CI 347 to 468). PICU beds increased by 16.0% (66.9 beds per year; 95% CI 53 to 81), primarily at children's hospitals. Rural areas experienced steeper proportional declines in pediatric inpatient unit beds (-26.1% vs -10.0%). Most states experienced decreases in both pediatric inpatient unit beds (median state -18.5%) and pediatric inpatient days (median state -10.0%). Nearly one-quarter of US children experienced an increase in distance to their nearest pediatric inpatient unit. Low-volume pediatric units and those without an associated PICU were at highest risk of closing.

Conclusions: Pediatric inpatient unit capacity is decreasing in the United States. Access to inpatient care is declining for many children, particularly those in rural areas. PICU beds are increasing, primarily at large children's hospitals. Policy and surge planning improvements may be needed to mitigate the effects of these changes.

Figure 1.. Trends in pediatric inpatient bed capacity and utilization by state.

Shown are percentage changes in number of statewide pediatric inpatient days (blue) and number of pediatric inpatient beds (orange) by state. States are ordered by change in beds. The changes are shown relative to the state’s baseline, which was defined as the state’s first year with available bed and hospitalization counts. Inpatient day utilization data was obtained from HCUPnet.

Figure 2.. Change in distance to pediatric inpatient units by urbanicity.

Change in distance to the nearest pediatric inpatient unit from baseline is shown for each year of the study for children living in urban, micropolitan, and rural areas. About one quarter of all children experienced an increase in distance to nearest pediatric input by the end of the study period. Children living in micropolitan or rural locations experienced larger changes in distance than those living in urban areas.

Figure 3.. Distance to pediatric inpatient and intensive care unit services.

A heat map of distance to nearest pediatric inpatient unit and PICU, respectively, are shown by census block group for 2018. Areas which experienced a change in distance to the nearest pediatric inpatient unit and PICU from 2009 to 2018 are highlighted at differing distance thresholds.