RECENT PHYSICIAN-REPORTED TRENDS IN THE HOSPITALIZATION OF U.S. CHILDREN   Ted D. Sigrest, Erin R. Stucky, Peter G. Szilagyi, Karen G. O'Connor.. Pediatrics, Univ of Rochester, Rochester, NY; Pediatrics, Childrens Hospital, San Diego, CA; Division of Research, American Academy of Pediatrics, Elk Grove, IL.  Presented at the 2007 Pediatric Academic Societies' Annual Meeting.

Background: Anecdotal evidence suggests that pediatric inpatient units in local/regional community hospitals are either being closed or merged with adult services, resulting in increased admissions to sometimes distant academic medical centers (AMCs).

Objective: To survey (1) pediatric inpatient unit closures and mergers, (2) changes in hospitalization practices of office-based pediatricians (OBPs), and (3) possible overcrowding of pediatric units in AMCs.

Design/Methods: National, random sample, mailed Periodic Survey of 2,088 AAP members in 2005. Of the 49% who responded and provided usable data (799): 42% were OBPs affiliated with local/regional hospitals and 58% were pediatricians (AMCPs) affiliated with AMCs.

Results: A total of 4% of the OBPs reported that their local hospital had dropped pediatric inpatient services within the past 10 yr, while 22% stated that their local pediatric unit had been merged with adult services. Almost half of OBPs (47%) reported that over the past 5 yr they had admitted a smaller percentage of their hospitalized patients locally. There were no obvious trends in percent of patients referred to local hospitalists/subspecialists, nor in percent of patients referred to AMCs. The need for advanced care was cited as the primary reason for transfer of patients to AMCs by 74% of OBPs. Lack of time/desire to do inpatient care was never a factor in referral for 95%. Shortages of local beds or nursing staff were rarely the cause of referrals for 79 and 69%, respectively. On the other hand, 64% of AMCPs noted rising occupancy rates and over half (53%) reported delays in admissions because of bed shortages. Constant (14%) or frequent (47%) problems in communication with AMC inpatient services were reported by referring OBPs.

Conclusions: This study suggests that pediatric hospital utilization patterns are changing, with local hospitals more likely to be reported as losing services or patients, and AMCs more likely to be reported as having delays in admissions because of lack of bed space. Research is needed to substantiate these findings, place them in proper context with other ongoing financial and demographic trends, and assist leaders in making decisions concerning the future distribution and quality of pediatric inpatient care.