八个州儿科急症医院转诊区域的发展与评估。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics Pub Date : 2024-10-16 DOI:10.1016/j.jpeds.2024.114371

Allan M. Joseph MD, MPH , John S. Minturn MAS , Kristen S. Kurland BA , Billie S. Davis PhD , Jeremy M. Kahn MD, MS

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引用次数: 0

摘要

研究目的研究设计：研究设计：我们利用州一级的行政数据库，收集了八个州的所有儿科急症护理信息，构建了新的转诊区域。我们首先根据 5,837,464 次儿科急诊就诊记录构建了儿科医院服务区（PHSAs）。然后，我们根据 344,440 例儿科住院病例，将这些 PHSA 聚合为儿科医院转诊区域 (PHRR)。最后，我们使用三种空间精确度测量方法（定位指数、市场份额指数和净病人流量）将这一新型区域系统与达特茅斯地图集（最初设计用于研究成人专科医疗）和匹兹堡地图集（最初设计用于研究成人急诊医疗）进行比较：结果：开发过程产生了 717 个新型 PHSA，然后将其汇总到所包含州的 55 个 PHRR。与达特茅斯地图集和匹兹堡地图集中的 HRRs 相比，PHRRs 的数量更少，面积更大，人口更多。PHRRs 更准确地反映了儿科住院治疗的模式（例如，平均定位指数为 69.1（满分 100），而 HRRs 为 69.1（满分 100））：结论：结论：使用专为研究儿科急症护理而设计的地区定义比使用现有的地区定义更能反映当代儿科急症护理的提供情况。未来的工作应将这些定义扩展到美国所有州，以便对儿科急症护理服务进行全国性分析。

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Development and Evaluation of Pediatric Acute Care Hospital Referral Regions in Eight States

Objective

To develop a set of pediatric acute care hospital referral regions for use in studying pediatric acute care delivery and test their utility relative to other regional systems.

Study design

We used state-level administrative databases capturing all pediatric acute care in 8 states to construct novel referral regions. We first constructed pediatric hospital service areas (PHSAs) based on 5 837 464 pediatric emergency department encounters. We then aggregated these PHSAs to pediatric hospital referral regions (PHRRs) based on 344 440 pediatric hospitalizations. Finally, we used 3 measures of spatial accuracy (localization index, market share index, and net patient flow) to compare this novel region system with the Dartmouth Atlas, designed originally to study adult specialty care, and the Pittsburgh Atlas, designed originally to study adult acute care.

Results

The development procedure resulted in 717 novel PHSAs, which were then aggregated to 55 PHRRs across the included states. Relative to hospital referral regions in the Dartmouth and Pittsburgh Atlases, PHRRs were fewer in number and larger in area and population. PHRRs more accurately captured patterns of pediatric hospitalizations, (eg, mean localization index: 69.1 out of 100, compared with a mean of 58.1 for the Dartmouth Atlas and 62.4 for the Pittsburgh Atlas).

Conclusions

The use of regional definitions designed specifically to study pediatric acute care better captures contemporary pediatric acute care delivery than the use of existing regional definitions. Future work should extend these definitions to all US states to enable national analyses of pediatric acute care delivery.

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来源期刊

Journal of Pediatrics 医学-小儿科

CiteScore

6.00

自引率

2.00%

发文量

696

审稿时长

31 days

期刊介绍： The Journal of Pediatrics is an international peer-reviewed journal that advances pediatric research and serves as a practical guide for pediatricians who manage health and diagnose and treat disorders in infants, children, and adolescents. The Journal publishes original work based on standards of excellence and expert review. The Journal seeks to publish high quality original articles that are immediately applicable to practice (basic science, translational research, evidence-based medicine), brief clinical and laboratory case reports, medical progress, expert commentary, grand rounds, insightful editorials, “classic” physical examinations, and novel insights into clinical and academic pediatric medicine related to every aspect of child health. Published monthly since 1932, The Journal of Pediatrics continues to promote the latest developments in pediatric medicine, child health, policy, and advocacy. Topics covered in The Journal of Pediatrics include, but are not limited to: General Pediatrics Pediatric Subspecialties Adolescent Medicine Allergy and Immunology Cardiology Critical Care Medicine Developmental-Behavioral Medicine Endocrinology Gastroenterology Hematology-Oncology Infectious Diseases Neonatal-Perinatal Medicine Nephrology Neurology Emergency Medicine Pulmonology Rheumatology Genetics Ethics Health Service Research Pediatric Hospitalist Medicine.