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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
L Remy, PhD1, Geraldine Oliva, MD MPH2, and T Clay, MS1. (1) Family Health Outcomes Project, University of California San Francisco, 3333 California Street, Room 365, San Francisco, CA 94118, 1-415-435-5439, lremy@itsa.ucsf.edu, (2) Family Health Outcomes Project, University of California, San Francisco, 3333 California Street, Suite 365, San Francisco, CA 94118
Between 1983 and 2000, complications of care, extended length of stay, and non-routine dispositions increased significantly for California's hospitalized children. During this period California instituted major public healthcare initiatives that differentially affected geographic areas and age and ethnic subgroups of children. OBJECTIVES: To determine the relationship between geographic trends in children's hospital outcomes and hospital infrastructure changes that accompanied these outcomes. METHODS: Hospital discharge files for 1983-2000 were searched to identify California residents age 30 days to 14 years, the legislated age range for care in hospital Pediatric Acute Care Units (PACU). Discharge records were summarized within year and merged with annual hospital and population files. RESULTS: In 1983, 218 of 557 hospitals discharging children age 30 days to 14 years held Pediatric Acute Care Unit (PACU) licenses for 4,861 beds to serve a population of 5.7 million children, or 1,164 children per PACU bed. By 2000, 147 hospitals previously admitting children closed, 177 of 410 hospitals discharging children held PACU licenses for 4,006 beds to serve a population of 8.1 million children, or 2,013 children per PACU bed. The number of child admissions to hospitals not holding PACU licenses increased. Unwanted outcomes were associated with occupancy and vacancy rates, Medicaid admission rates, the availability of emergency rooms and licensed PACU beds. Geographic differences in adverse outcomes correlated with geographic differences in hospital infrastructure. CONCLUSION: Regional variations in California's Medicaid and managed care expansions impacted both the willingness of hospitals to treat children and the quality of child outcomes.
Learning Objectives:
Keywords: Quality of Care, Hospitals
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.