359 - Regionalization of Pediatric Inpatient Care: A Scoping Review of Trends, Causes, and Impacts

Publication Number: 4352.359

Nora Pfaff, University of California, San Francisco, School of Medicine, San Bruno, CA, United States; Jennifer Lee, University of California, San Francisco, School of Medicine, Walnut Creek, CA, United States; Kathleen Bonsmith, University of California, San Francisco, School of Medicine, Alameda, CA, United States

Background: Pediatric inpatient care has become increasingly regionalized, with definitive acute care shifting to referral centers and a steady rise in pediatric unit closures at rural and community hospitals.

Objective: To review studies examining the trends, drivers, and consequences of pediatric inpatient care regionalization and of closures of pediatric acute care units in rural and community hospitals.

Design/Methods: We conducted a scoping review of pediatric (ages 0-18 years) studies originating from the United States and published in English in PubMed from 1995-2024. Eligible designs included retrospective, cohort, survey, qualitative, mixed-methods, systematic, and scoping review. We excluded editorials, opinion pieces, and abstracts without an accompanying paper. Three reviewers independently screened 6,950 records using Rayyan software. Two reviewers independently evaluated each abstract, with near-perfect agreement (99.5–99.8%; κ = 0.99–1.00); conflicts were resolved by consensus. Of these, 21 studies met final inclusion criteria, 1 article was added after full text review, and 3 studies were identified after reference review. Extracted data included regionalization trends, drawbacks, benefits, impacts on physician workforce, and patient/family outcomes and experiences.

Results: Twenty-five studies were included. Most (20/25) described increasing regionalization in the last 30 years. Ten studies examined drawbacks or pitfalls resulting from pediatric regionalization, including decreasing capability of local hospitals to provide definitive care to children, increased travel distance and costs to families, and overcrowding of tertiary care centers. Seven studies highlighted the benefits of pediatric regionalization, revealing better outcomes for patients with specific conditions such as seizure disorders, congenital heart disease, and non-accidental trauma as well as decreased mortality in surgical patients. No studies examined the impacts on the physician workforce, and while several studies mentioned the need to evaluate patient and family experiences secondary to regionalization, none directly addressed these concerns.

Conclusion(s): Regionalization of inpatient pediatric care has significantly increased over the last 30 years, improving outcomes for select conditions and specialty surgical care while exacerbating disparities in access to definitive pediatric acute care in rural and community settings. Future research should explore the effects on the physician workforce and hospitalist job satisfaction as well as impacts on patients and families.