Access to Pediatric Bed Capacity According to Social Determinants of Health: All Beds Are Not Created Equal

Thomas A Hegland; R Thomas Day Jr; Katie M Moynihan

doi:10.1016/j.jpeds.2024.114447

Access to Pediatric Bed Capacity According to Social Determinants of Health: All Beds Are Not Created Equal

J Pediatr. 2024 Dec 21:114447. doi: 10.1016/j.jpeds.2024.114447. Online ahead of print.

Authors

Thomas A Hegland¹, R Thomas Day Jr², Katie M Moynihan³

Affiliations

¹ Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD, USA.
² Department of Pediatrics, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
³ Department of Pediatrics, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA, USA. Electronic address: [email protected].

PMID: 39716543
DOI: 10.1016/j.jpeds.2024.114447

Abstract

Objective: To study pediatric inpatient hospital capacity and resources, characterizing differences according to social determinants of health (SDoH) using market share techniques.

Study design: This cross-sectional study uses non-elective inpatient discharges (≥1 month to ≤19 years) from Healthcare Cost and Utilization Project and American Hospital Association surveys to derive hospital capacity and resources/capability. We include US hospitals with ≥1 pediatric bed and ≥1 pediatric discharge and calculate per bed capital, expenditure, and staffing, transfer rates, payer-mix, and adjusted central line-associated blood stream infection (CLABSI) rate. We utilize actual discharge data to improve upon traditional geospatial access analyses that assume all patients receive care close to home. SDoH are derived from American Community Survey measures (family income, race and ethnicity, and urban versus rural) and Child Opportunity Index (COI).

Results: Using 1,118,502 discharges across 1,404 hospitals, mean pediatric bed capacity was 3.26 beds per 10,000 pediatric-aged residents (95% CI: 3.24-3.29). Capacity was similar across racial and ethnic groups, although socially disadvantaged (low income or COI) areas had higher capacity. Hospitals serving non-Hispanic/Latino Black and Hispanic/Latino children, children from socially disadvantaged communities, and rural areas had lower capital, expenditure, and staff per bed; higher transfer rates; and served more Medicaid enrollees. Hospitals serving very-high COI areas had $284,000 greater expenditure per bed (versus very low) and a 16% lower proportion of Medicaid patients. CLABSI rates did not substantively differ by SDoH.

Conclusions: Although pediatric bed capacity was evenly distributed according to SDoH, hospitals serving under-represented, disadvantaged, and rural communities had less capability and resource availability. Future work is required to guide equity-oriented resource allocation.

Keywords: Capital Expenditures; Child; Delivery of Health Care; Ethnicity; Hospital Beds; Hospital Capacity; Medicaid; Patient Discharge; Pediatric Beds; Pediatric Hospital Capacity; Resource Allocation; Rural Population; Social Determinants of Health; United States.