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Closure of Licensed Pediatric Beds in Health Care Markets Within Illinois

  • Author Footnotes
    # Dr VonAchen is now with Boston Children's Hospital, Boston, Mass.
    Paige VonAchen
    Correspondence
    Address correspondence to Paige VonAchen, MD, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611
    Footnotes
    # Dr VonAchen is now with Boston Children's Hospital, Boston, Mass.
    Affiliations
    Mary Ann & J. Milburn Smith Child Health Outreach, Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago (P VonAchen, MM Davis, J Cartland, A D'Arco, and K Kan), Chicago, Ill

    University of Michigan Medical School (P VonAchen), Ann Arbor, Mich
    Search for articles by this author
  • Matthew M. Davis
    Affiliations
    Mary Ann & J. Milburn Smith Child Health Outreach, Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago (P VonAchen, MM Davis, J Cartland, A D'Arco, and K Kan), Chicago, Ill

    Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine (MM Davis and K Kan), Chicago, Ill
    Search for articles by this author
  • Jenifer Cartland
    Affiliations
    Mary Ann & J. Milburn Smith Child Health Outreach, Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago (P VonAchen, MM Davis, J Cartland, A D'Arco, and K Kan), Chicago, Ill
    Search for articles by this author
  • Amy D'Arco
    Affiliations
    Mary Ann & J. Milburn Smith Child Health Outreach, Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago (P VonAchen, MM Davis, J Cartland, A D'Arco, and K Kan), Chicago, Ill
    Search for articles by this author
  • Kristin Kan
    Affiliations
    Mary Ann & J. Milburn Smith Child Health Outreach, Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago (P VonAchen, MM Davis, J Cartland, A D'Arco, and K Kan), Chicago, Ill

    Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Northwestern University Feinberg School of Medicine (MM Davis and K Kan), Chicago, Ill
    Search for articles by this author
  • Author Footnotes
    # Dr VonAchen is now with Boston Children's Hospital, Boston, Mass.

      Abstract

      Objective

      Our objective was to understand the market characteristics related to closures of licensed pediatric hospital beds that may be related to increasing regionalization of pediatric hospital care.

      Methods

      We performed a retrospective descriptive analysis of 110 hospitals with licensed pediatric hospital beds from a statewide survey of health care facilities (2012–2017) and administrative data of hospital admissions (2013–2018) in Illinois. We quantified closures of licensed pediatric hospital beds and categorized hospital bed closures by hospital and market characteristics.

      Results

      From 2012 through 2017, the number of licensed pediatric beds declined from 1706 to 1254 (-26.5%). Over the same time period, annual pediatric inpatient days minimally changed (+1.1%), while annual pediatric inpatient days at hospitals affiliated with the Children's Hospital Association increased (+30.5%). After accounting for re-openings, the 33 hospitals that closed all licensed pediatric beds fit 4 distinct typologies: 1) Hospitals with minimal pediatric volume throughout the study (n = 19); 2) Hospitals that sustained at least 50% of their pediatric volume after closure of licensed pediatric beds (n = 8); 3) Hospitals with low market share in metropolitan areas (n = 5); and 4) Hospital with a decline in pediatric market share, while a nearby hospital saw a corresponding rise in pediatric market share (n = 1).

      Conclusions

      In Illinois, licensed pediatric hospital beds declined while pediatrics inpatient days stayed the same over a recent 6-year period. Typologies of closures describe the nuanced dynamics leading to decline of pediatric hospital beds. Understanding these patterns is critical to ensure that children receive quality pediatric-tailored care.

      Keywords

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      References

        • CON-Certificate of Need State Laws
        National conference of state legislatures.
        2019 (Available at: https://www.ncsl.org/research/health/con-certificate-of-need-state-laws.aspx#1. Accessed December 15, 2019)
        • California Health and Human Services Agency, Office of Statewide Health Planning and Development, Annual Hospital Utilization Data
        Licensed Bed Classification and Designation Trends.
        2015 (Available at: https://data.chhs.ca.gov/dataset/licensed-bed-classification-and-designations-trends. Accessed June 15, 2019)
        • Frost P.
        Pediatric surge planning. Solutions within reach.
        in: California Hospital Association Disaster Conference (presentation). 2010
        • Yoshino k
        Pediatric care shrinks statewide.
        Los Angeles Times, 2009 (Available at: https://www.latimes.com/archives/la-xpm-2009-jan-25-me-pediatric-hospital25-story.html. Accessed June 15, 2019)
        • França UL
        • McManus ML.
        Availability of definitive hospital care for children.
        JAMA Pediatr. 2017; 171e171096https://doi.org/10.1001/jamapediatrics.2017.1096
        • França UL
        • McManus ML.
        Trends in regionalization of hospital care for common pediatric conditions.
        Pediatrics. 2018; 141https://doi.org/10.1542/peds.2019-2989
        • Cushing AM
        • Bucholz E
        • Michelson KA.
        Trends in regionalization of emergency care for common pediatric conditions.
        Pediatrics. 2020; 145https://doi.org/10.1542/peds.2019-2989
        • Bucholz EM
        • Toomey SL
        • Schuster MA.
        Trends in pediatric hospitalizations and readmissions: 2010-2016.
        Pediatrics. 2019; 143https://doi.org/10.1542/peds.2018-1958
        • Kaufman BG
        • Thomas SR
        • Randolph RK
        • et al.
        The rising rate of rural hospital closures.
        J Rural Health. 2016; 32: 35-43https://doi.org/10.1111/jrh.12128
        • Cuellar AE
        • Gertler PJ.
        Trends in hospital consolidation: the formation of local systems.
        Health Aff (Millwood). 2003; 22: 77-87https://doi.org/10.1377/hlthaff.22.6.77
        • Harrison TD.
        Consolidations and closures: an empirical analysis of exits from the hospital industry.
        Health Econ. 2007; 16: 457-474https://doi.org/10.1002/hec.1174
        • Friedman AB
        • Owen DD
        • Perez VE.
        Trends in hospital ED closures nationwide and across Medicaid expansion, 2006-2013.
        Am J Emerg Med. 2016; 34: 1262-1264https://doi.org/10.1016/j.ajem.2016.04.006
        • Pai DR
        • Hosseini H
        • Brown RS.
        Does efficiency and quality of care affect hospital closures?.
        Health Syst (Basingstoke). 2019; 8: 17-30https://doi.org/10.1080/20476965.2017.1405874
        • Hsia RY
        • Shen YC.
        Emergency department closures and openings: spillover effects on patient outcomes in bystander hospitals.
        Health Aff (Millwood). 2019; 38: 1496-1504https://doi.org/10.1377/hlthaff.2019.00125
        • Bindman AB
        • Keane D
        • Lurie N.
        A public hospital closes. Impact on patients' access to care and health status.
        JAMA. 1990; 264: 2899-2904https://doi.org/10.1001/jama.264.22.2899
        • Hsia RY
        • Kellermann AL
        • Shen YC.
        Factors associated with closures of emergency departments in the United States.
        JAMA. 2011; 305: 1978-1985https://doi.org/10.1001/jama.2011.620
        • Lorch SA
        • Srinivas SK
        • Ahlberg C
        • et al.
        The impact of obstetric unit closures on maternal and infant pregnancy outcomes.
        Health Serv Res. 2013; 48: 455-475https://doi.org/10.1111/j.1475-6773.2012.01455.x
        • Thomas SR
        • Holmes GM
        • Pink GH.
        To what extent do community characteristics explain differences in closure among financially distressed rural hospitals?.
        J Health Care Poor Underserved. 2016; 27: 194-203https://doi.org/10.1353/hpu.2016.0176
        • Holmes GM
        • Kaufman BG
        • Pink GH.
        Predicting financial distress and closure in rural hospitals.
        J Rural Health. 2017; 33: 239-249https://doi.org/10.1111/jrh.12187
        • Succi MJ
        • Lee SY
        • Alexander JA.
        Effects of market position and competition on rural hospital closures.
        Health Serv Res. 1997; 31: 679-699
        • Buchmueller TC
        • Jacobson M
        • Wold C.
        How far to the hospital? The effect of hospital closures on access to care.
        J Health Econ. 2006; 25: 740-761https://doi.org/10.1016/j.jhealeco.2005.10.006
        • Brooks GR
        • Jones VG.
        Hospital mergers and market overlap.
        Health Serv Res. 1997; 31: 701-722
        • Lindrooth RC
        • Lo Sasso AT
        • Bazzoli GJ
        The effect of urban hospital closure on markets.
        J Health Econ. 2003; 22: 691-712https://doi.org/10.1016/s0167-6296(03)00060-2
        • Capps C
        • Dranove D
        • Lindrooth RC.
        Hospital closure and economic efficiency.
        J Health Econ. 2010; 29: 87-109https://doi.org/10.1016/j.jhealeco.2009.10.006
        • Yee JD
        • Shelton D
        • Girouard S
        • et al.
        Market forces and organizational evolution at freestanding children's hospitals in the United States.
        Ambul Pediatr. 2001; 1: 117-121https://doi.org/10.1367/1539-4409(2001)001<0117:mfaoea>2.0.co;2
        • Stang AS
        • Joshi A.
        The evolution of freestanding children's hospitals in Canada.
        Paediatr Child Health. 2006; 11: 501-506https://doi.org/10.1093/pch/11.8.501
        • Khare M
        • Rauch DA.
        Trends in national pediatric bed census.
        Pediatrics. 2017; 140: 20https://doi.org/10.1542/peds.140.1_MeetingAbstract.20
      1. Children's Hospital Association. Children's Hospital Directory. Available at: https://www.childrenshospitals.org/Directories/Hospital-Directory?state=IL. Accessed March 29, 2021.

      2. U.S. Office of Management and Budget. Metropolitan and Micropolitan. Available at: https://www.census.gov/programs-surveys/metro-micro.html (Accessed June 15, 2019).

        • Berry JG
        • Hall M
        • Hall DE
        • et al.
        Inpatient growth and resource use in 28 children's hospitals: a longitudinal, multi-institutional study.
        JAMA Pediatr. 2013; 167: 170-177https://doi.org/10.1001/jamapediatrics.2013.432
        • Witt WP
        • Weiss AJ
        • Elixhauser A.
        Overview of Hospital Stays for Children in the United States, 2012.
        Agency for Healthcare Research and Quality, Rockville, Md2014 (HCUP Statistical Brief #187)
        • Cilla G
        • Gomariz M
        • Montes M
        • et al.
        Incidence of hospitalization due to community-acquired rotavirus infection: a 12-year study (1996-2008).
        Epidemiol Infect. 2010; 138: 1235-1241https://doi.org/10.1017/s095026881000004x
        • Hartman ME
        • Linde-Zwirble WT
        • Angus DC
        • et al.
        Trends in admissions for pediatric status asthmaticus in New Jersey over a 15-year period.
        Pediatrics. 2010; 126: e904-e911https://doi.org/10.1542/peds.2009-3239
        • Gupta R
        • Anderson HR
        • Strachan DP
        • et al.
        International trends in admissions and drug sales for asthma.
        Int J Tuberc Lung Dis. 2006; 10: 138-145
        • Finkelstein A
        • Gentzkow M
        • Williams H.
        Sources of geographic variation in health care: evidence from patient migration.
        Q J Econ. 2016; 131: 1681-1726https://doi.org/10.1093/qje/qjw023
        • Newhouse JP
        • Garber AM.
        Geographic variation in Medicare services.
        N Engl J Med. 2013; 368: 1465-1468https://doi.org/10.1056/NEJMp1302981
        • Rosenberg BL
        • Kellar JA
        • Labno A
        • et al.
        Quantifying geographic variation in health care outcomes in the United States before and after risk-adjustment.
        PLoS One. 2016; 11e0166762https://doi.org/10.1371/journal.pone.0166762
        • Gittelsohn WJ
        Small area variations in health care delivery.
        Science. 1973; 182: 1102-1108https://doi.org/10.1126/science.182.4117.1102
        • Perrin K.
        A first for this century: closing and reopening of a children's hospital during a disaster.
        Pediatrics. 2006; 117: S381-S385https://doi.org/10.1542/peds.2006-0099H
        • Leyenaar JK
        • Ralston SL
        • Shieh MS
        • et al.
        Epidemiology of pediatric hospitalizations at general hospitals and freestanding children's hospitals in the United States.
        J Hosp Med. 2016; 11: 743-749https://doi.org/10.1002/jhm.2624
        • Colvin JD
        • Hall M
        • Gottlieb L
        • et al.
        Hospitalizations of low-income children and children with severe health conditions: implications of the Patient Protection and Affordable Care Act.
        JAMA Pediatr. 2016; 170: 176-178https://doi.org/10.1001/jamapediatrics.2015.3366
        • Synhorst DC
        • Hall M
        • Harris M
        • et al.
        Hospital observation status and readmission rates.
        Pediatrics. 2020; 146https://doi.org/10.1542/peds.2020-003954
      3. The Dartmouth Institute for Health Policy and Clinical Practice. Dartmouth Atlas Data FAQs. Available at: https://www.dartmouthatlas.org/faq/#research-methods-faq Accessed March 15, 2021.