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Children in rural areas face increasing barriers to pediatric care – Boston, Massachusetts

Boston, Massachusetts 2021-06-14 00:01:52 –

HHospital beds for children with asthma, pneumonia, viral infections, and other serious illnesses have declined over the past decade, primarily in rural areas.In a new study published on Monday PediatricsResearchers have found that the proportion of US hospitals with inpatient wards for pediatric treatment has decreased, and the number of beds in open wards has also decreased.

The number of hospitalized patients decreased by 19% and the number of beds decreased by 12%. On average, about 34 pediatric units were closed and 300 beds were removed each year. Bed closures and losses were particularly acute in rural areas rather than in urban areas. Researchers have found that one in four children must travel farther to access hospital care for inpatients than they did ten years ago.

This is a familiar situation for Sunitha Kaiser, a pediatric hospitalist at the University of California, San Francisco. “I’ve seen all those issues,” she said. “Children become unstable during long journeys, stay longer, and have difficulty leaving their families far away while their children are in the hospital.”

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Anna Cushing, lead author of the study and pediatric emergency fellow at the Los Angeles Children’s Hospital, said it is common to receive patients in a condition that is normally treated in a regional hospital. This can exacerbate other health outcomes by worsening family health care costs, increasing infant mortality, and prolonging the time to receive potentially life-saving treatments, Kaiser said. Stated.

Depletion of local resources can affect hospitals’ ability to cope with disaster and pandemic spikes. A Record number of local hospital closures in 2020 Children were much better than adults during this pandemic, with reduced access to care for some Covid patients and others, but “preparing for something of the same size as pediatrics is probably No, “Cushing said.

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In the last 10 years Local hospitals have been reduced We provide a variety of services such as skilled nursing care, obstetrics, and home medical care. Pediatrics is the next step in following this trend, especially as child care is shifting from general regional hospitals to more specialized children’s hospitals and academic centers in major cities. Localization..

Localization may allow for more specialized care for children with special disabilities, but in certain areas, excluding many rural areas where one in five children live. Concentrate resources. “The advantage of community medicine is that under the roof of one hospital, children can be treated by different specialists,” said the pediatric hospitalist and pediatrician at the Dartmas Hitchcock Medical Center, who was not involved in the study. Professor Jo Anna Leyenaar said. “But the price is often that care cannot be provided near the home.”

To better understand these trends in pediatric care, researchers at Harvard Medical School and Boston Children’s Hospital examined data on 4,720 US hospitals. Research According to the American Hospital Association from 2008 to 2018. One limitation was that the data could be self-reported, leading to miscounting or misclassification.

The capacity of inpatient pediatric care has declined, especially in rural areas. In contrast, pediatric intensive care units have increased in children’s hospitals, highlighting this localization process.

Experts say these dynamics may be due to reduced demand, as pediatric hospitalizations are also reduced and lengths of stay are shorter. But another possible reason to explain the closure is The cost of keeping these units open At a hospital with insufficient funds. “Given the pediatric ICU bed, it’s expensive to empty,” said Mark Holmes, a professor at the University of North Carolina who wasn’t involved in the study. For small rural hospitals that accept a significant number of patients covered by Medicaid, which has lower medical costs than private insurance companies, the cost of keeping their beds open can be difficult to manage.

“These little units, which are the little gears in the big wheel of the hospital, are very difficult to catch up economically over time,” said Kaiser, who was not involved in the study. “The important next step is to understand why these units close and the best way to keep them open.”

Not only do we need to identify which hospitals are reducing pediatric care, but we also need to understand which children and specific communities are affected. Studies show that rural hospitals are more likely to be closed if they serve non-white people, increasing the risk of children and colored communities.

In addition to race and ethnicity, it is also important to understand the socio-economic status of children who have lost access to pediatrics. “Is there anything about the types of places that are experiencing this?” Holmes said. These various factors, geography, socioeconomic status, race and / or ethnicity, Attacks already vulnerable communities most violently..

The authors of the study have proposed several strategies for dealing with pediatric bed loss. For example, establish a partnership with a general hospital and a more resource-rich children’s hospital and specify a vulnerable pediatric hospital ward as follows: Important access center, And investment in telemedicine.

Researchers said this and future studies will help policy makers understand where resources need to be allocated. In the case of Cushing’s Syndrome, this study lays the foundation for helping children everywhere. “We need to be able to take care of all the children there, whether they live on the street or are hours away.”



Children in rural areas face increasing barriers to pediatric care Source link Children in rural areas face increasing barriers to pediatric care

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