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. 2025 Jan:276:114371.
doi: 10.1016/j.jpeds.2024.114371. Epub 2024 Oct 16.

Development and Evaluation of Pediatric Acute Care Hospital Referral Regions in Eight States

Allan M Joseph  1 , John S Minturn  1 , Kristen S Kurland  2 , Billie S Davis  1 , Jeremy M Kahn  3
Affiliations

Development and Evaluation of Pediatric Acute Care Hospital Referral Regions in Eight States

Allan M Joseph et al. J Pediatr. 2025 Jan.

Abstract

Objective: To develop a set of pediatric acute care hospital referral regions for use in studying pediatric acute care delivery and test their utility relative to other regional systems.

Study design: We used state-level administrative databases capturing all pediatric acute care in 8 states to construct novel referral regions. We first constructed pediatric hospital service areas (PHSAs) based on 5 837 464 pediatric emergency department encounters. We then aggregated these PHSAs to pediatric hospital referral regions (PHRRs) based on 344 440 pediatric hospitalizations. Finally, we used 3 measures of spatial accuracy (localization index, market share index, and net patient flow) to compare this novel region system with the Dartmouth Atlas, designed originally to study adult specialty care, and the Pittsburgh Atlas, designed originally to study adult acute care.

Results: The development procedure resulted in 717 novel PHSAs, which were then aggregated to 55 PHRRs across the included states. Relative to hospital referral regions in the Dartmouth and Pittsburgh Atlases, PHRRs were fewer in number and larger in area and population. PHRRs more accurately captured patterns of pediatric hospitalizations, (eg, mean localization index: 69.1 out of 100, compared with a mean of 58.1 for the Dartmouth Atlas and 62.4 for the Pittsburgh Atlas).

Conclusions: The use of regional definitions designed specifically to study pediatric acute care better captures contemporary pediatric acute care delivery than the use of existing regional definitions. Future work should extend these definitions to all US states to enable national analyses of pediatric acute care delivery.

Keywords: acute care; emergency medicine; geography; hospital medicine; pediatrics; regionalization.

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Conflict of interest statement

Declaration of Competing Interest Prof. Kurland has received compensation for textbook authorship from Esri, Inc, the maker of ArcGIS software used in this project. Dr Joseph was supported by a grant from the National Institutes of Health (5T32HL007820). The NIH had no role in the study design, data analysis, manuscript preparation, or decision to submit the manuscript for publication.

Figures

Figure 1.
Figure 1.
Schemata describing the measures of spatial accuracy. We used 3 geographic accuracy measures: localization index, market share index, and net patient flow. These measures evaluate the accuracy of region constructions, as they relate to where patients live and receive their acute care. Adapted from Wallace et al.
Figure 2.
Figure 2.
Differences in hospital referral region systems in Iowa.
Figure 3.
Figure 3.
Comparison of spatial accuracy metrics among region systems. A, presents the localization dndex; B, presents the market share index; and C, presents the net patient flow. For clarity, the net patient flow metric is plotted on a log scale.
See this image and copyright information in PMC

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