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 At the root, they maintain, is the disappearance of pediatric
community hospital care.
The number of children transferred from one hospital to another
increased by more than 36 percent in Massachusetts from 2004 to
2014, and only about 20 percent of the state’s 66 hospitals
completed care for more than half of their pediatric patients
without transferring them, the research team reports in JAMA
Pediatrics.
“Pediatric hospital care is less available than it used to be,
mostly because community hospitals are increasingly transferring
children to larger centers,” said senior author Dr. Michael McManus,
a pediatrician and professor at Harvard Medical School in Boston.
“Transfer can greatly improve care for some conditions,” he said in
an email, “but can delay and potentially worsen care for others.”
The research showed consolidation of care into regional centers for
both adults and children over the decade studied. But the move to
regional care for children far outpaced that for adults.
The likelihood of a hospital completing a child’s care without a
transfer dropped by 65 percent from 2004 to 2014, while the
likelihood of a hospital completing an adult’s care without a
transfer fell by 11 percent, the study found.
Dr. Nicholas Mohr, a professor at the University of Iowa Carver
College of Medicine in Iowa City, said doctors have seen the trend
in hospitals throughout the U.S. But the number of children
transferred between Massachusetts hospitals surprised him.
“Fewer children are being cared for in community hospitals,” he said
in a phone interview. “The big question is whether that’s good or
bad.”
“We don’t know what the outcome differences are. That’s the
million-dollar question,” said Mohr, who was not involved in the
study.
Altogether, the researchers analyzed more than 34 million emergency
department as well as inpatient and observation admissions, using
data from every acute-care hospital in Massachusetts for 10 years.
Transfer from a hospital generally indicates that it lacked the
capability to treat the patient, the authors write.
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Although pediatric emergency department visits decreased nearly 3
percent and admissions fell 15 percent, pediatric transfers
increased 36 percent over the 10 years, the study found.
The findings could be interpreted to mean that children now get
better medical care in more specialized sites. But many of the
children moved from one hospital to another were treated for
conditions as common as broken limbs, or asthma.
Mohr said the consolidation of hospital care is a well-known factor
for both adults and children these days.
“At the same time we have hospitals in some parts of the country
closing, tertiary care centers are bursting at the seams,” he said.
“It’s striking that both of these things are happening at the same
time.”“If quality of care is no better, then we’re looking at an
unsupported practice that’s increasing cost and waste. The big
glaring question is whether regionalized care is better,” he said.
The new study can’t answer the question.
A previous study showed that almost a quarter of American children
were transferred from one hospital to another for minor conditions
and then discharged directly home, while another 17 percent were
released in less than 24 hours.
McManus is conducting additional research to explore the myriad of
possible reasons for consolidation of pediatric hospital care.
In the meantime, he said, his study’s findings illustrate “how
pediatric systems of care are very different from adult systems and
need to be considered separately in public health and health policy
discussions.”
SOURCE: http://bit.ly/2uoA1tO JAMA Pediatrics, online July 10, 2017.
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