Michael McManus, MD
Senior Associate in Critical Care Medicine
Boston Children's Hospital, Massachusetts, United States
Disclosure information not submitted.
Nadine Straka, MD, MPH
Fellow, Pediatric Critical Care Medicine
Boston Childrens Hospital
Boston, Massachusetts
Disclosure information not submitted.
Title: Regional Variation in the Use of Pediatric Post-Acute Care
Introduction: Following admission to a pediatric intensive care unit, survivors can experience impairments in physical, cognitive and social functioning and may require inpatient rehabilitation, otherwise known as post-acute care (PAC). There is a paucity of research regarding the regional availability and use of pediatric PAC facilities. This study uses both the Pediatric Health Information System (PHIS) database as well as the Center for Medicare and Medicaid Services (CMS) database to examine this relationship.
Methods: Patients ≤ 18 years of age who were discharged after admission from a PHIS-participating hospital to a PAC facility between 2010 to 2020 were included. Demographics and hospital characteristics were reported using descriptive statistics by geographical division as defined by the US Census Bureau. Using CMS data (2020), a search filter was created to identify nationwide pediatric post-acute care facilities.
Results: Of 6,345,567 pediatric hospital discharges, 1.4% (85,792) were discharged to PAC facilities and 279 pediatric PAC facilities were identified. Most children discharged to PAC were under 1 year of age (IQR:1, 11). About 63% of patients were identified as having complex health care needs and 30% were technology dependent at the time of discharge. Of these patients, about 33% were admitted to the intensive care unit with a median length of stay of 5 days (IQR 2,15) and 36% were admitted to the neonatal intensive care unit with a median length of stay of 3 days (IQR 1,15). Areas with the highest use of PAC were East North Central (20.5%) and the Pacific (20%) divisions, where 16.8% and 10.0% of all pediatric PAC facilities reside, respectively. Conversely, areas with the lowest use of PAC were the East South Central (4.6%) and Mountain (4.6%) divisions, where 4.7% and 6.1% of pediatric PAC facilities, respectively. Areas with lower use of pediatric PAC tended to have higher median age at discharge and longer total hospital length of stay.
Conclusion: Compared to adults, discharge to PAC in pediatrics is rare and there is marked regional variability in its use. Pediatric discharge to PAC may be limited by the availability of facilities that are able to meet the needs of children with complex health issues following acute hospital admission and critical illness.