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J Am Coll Cardiol. 2015 Jul 7;66(1):37-44. doi: 10.1016/j.jacc.2015.04.053.

Variation in Use of Pediatric Cardiology Subspecialty Care: A Total Population Study in California, 1983 to 2011.

Author information

1
Department of Pediatrics, Division of General Pediatrics, Stanford University School of Medicine, Palo Alto, California. Electronic address: lchamberlain@stanford.edu.
2
Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, California; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California.
3
Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University School of Medicine, Palo Alto, California.
4
Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, California.
5
Department of Pediatrics, Division of General Pediatrics, Stanford University School of Medicine, Palo Alto, California; Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University School of Medicine, Palo Alto, California.
6
Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University School of Medicine, Palo Alto, California; Department of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Palo Alto, California.

Abstract

BACKGROUND:

American Academy of Pediatrics guidelines emphasize regionalized systems of care for pediatric chronic illness. There remains a paucity of information on the status of regionalized systems of care for pediatric congenital heart disease (CHD).

OBJECTIVES:

This study evaluated variations in use of pediatric cardiology specialty care centers (PCSCC) for pediatric patients with CHD in California between 1983 and 2011.

METHODS:

We performed a retrospective, total population analysis of pediatric CHD patients using the California Office of Statewide Health Planning and Development unmasked database. PCSCCs were identified by California's Title V program.

RESULTS:

There were 164,310 discharges meeting inclusion criterion. Discharges from PCSCCs grew from 58% to 88% between 1983 and 2011. Regionalized care was highest for surgical (96%) versus nonsurgical (71%) admissions. Admissions with a public payer increased from 42% (1983) to 61% (2011). Total bed days nearly doubled, and median length of stay increased from 2 to 3 days (nonspecialty care) and from 4 to 5 days (specialty care). There was a decrease in the pediatric CHD in-hospital death rate from 5.1 to 2.3 per 100,000 between 1983 and 2011, and a shift toward a larger percent of deaths occurring in the newborn period.

CONCLUSIONS:

California's inpatient regionalized specialty care of pediatric CHD has increased substantially since 1983, especially for surgical CHD discharges. The death rate has decreased, the number of bed days has increased, and a large proportion of these discharges now have public payers. Health care reform efforts must consider these shifts while protecting advances in regionalization of pediatric CHD care.

KEYWORDS:

congenital heart disease; congenital heart surgery; hospital volume; pediatric cardiology

PMID:
26139056
DOI:
10.1016/j.jacc.2015.04.053
[Indexed for MEDLINE]
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