176 - REACH: A Multidimensional Hospital Index for Measuring Pediatric Patient–Catchment Area Sociodemographic Concordance

Publication Number: 1165.176

Sreejata Dutta, Children's Hospital Association, Spring Hill, KS, United States; Valerie L. Ward, Boston Children's Hospital, Boston, MA, United States; Patricia A. Hickey, Boston Children's Hospital, Boston, MA, United States; Torey Mack, Children's Hospital Association, Washington, DC, DC, United States; Matt hall, Children's Hospital Association, Lenexa, KS, United States

Background: Evidence suggests that stronger sociodemographic concordance between children's hospitals and the communities they serve is associated with improved pediatric health outcomes. However, tools for systematically assessing this concordance are lacking.

Objective: To address the gap in measurement tools, we developed REACH (Representation and Equity in Area-based Child Hospitalizations), a multidimensional hospital index designed to quantify sociodemographic concordance between pediatric hospitalizations and surrounding communities.

Design/Methods: We analyzed 2023 hospitalizations from 48 children's hospitals in the Pediatric Health Information System (PHIS) alongside ZIP-level Census data. A distance-weighted algorithm was employed to define each hospital's catchment area. For each sociodemographic factor (ethnicity, payor, race, and sex), we calculated chi-square divergence between the observed and expected patient counts, weighted by residential proximity. Each index was scaled from 0 to 1, with higher values signifying greater concordance between patient and community sociodemographics. We used a beta distribution for estimating each component, resulting in a hospital-level composite index with 95% confidence intervals.

Results: A total of 302,541 hospitalizations were included. REACH scores ranged from 0.86 to 0.98 across hospitals (Fig 1). Concordance was consistently high across all four sociodemographic dimensions [ethnicity, payor, race, and sex] (≥0.85), with approximately half of the children's hospitals achieving very high concordance (≥0.95) in all categories (Fig 2).

Conclusion(s): The REACH index offers a robust framework for assessing sociodemographic alignment in pediatric hospital care. It enables benchmarking across hospitals and supports equity-driven quality improvement and policy initiatives.

The REACH index for 48 PHIS hospitals considering four demographic characteristics (ethnicity, payor, race, and sex). Error bars represent 95% confidence intervals.
REACH_48hosps.jpeg

Dimension specific indexes for 48 PHIS hospitals for (a) Ethnicity, (b) Payor, (c) Race, and (d) Sex.