Variation in specialty care hospitalization for children with chronic conditions in California.
OBJECTIVE
Despite the documented utility of regionalized systems of pediatric specialty care, little is known about the actual use of such systems in total populations of chronically ill children. The objective of this study was to evaluate variations and trends in regional patterns of specialty care hospitalization for children with chronic illness in California.


METHODS
Using California's Office of Statewide Health Planning and Development unmasked discharge data set between 1999 and 2007, we performed a retrospective, total-population analysis of variations in specialty care hospitalization for children with chronic illness in California. The main outcome measure was the use of pediatric specialty care centers for hospitalization of children with a chronic condition in California.


RESULTS
Analysis of 2 170 102 pediatric discharges revealed that 41% had a chronic condition, and 44% of these were discharged from specialty care centers. Specialty care hospitalization varied by county and type of condition. Multivariate analyses associated increased specialty care center use with public insurance and high pediatric specialty care bed supply. Decreased use of regionalized care was seen for adolescent patients, black, non-Hispanic children, and children who resided in zip codes of low income or were located farther from a regional center of care.


CONCLUSIONS
Significant variation exists in specialty care hospitalization among chronically ill children in California. These findings suggest a need for greater scrutiny of clinical practices and child health policies that shape patterns of hospitalization of children with serious chronic disease.
Chamberlain
Lisa J
LJ
Department of Pediatrics, Stanford University School of Medicine, 770 Welch Rd. 100, Palo Alto, CA 94304, USA. lchamberlain@stanford.edu
Chan
Jia
J
Mahlow
Pamela
P
Huffman
Lynne C
LC
Chan
Kristen
K
Wise
Paul H
PH
D000293:Adolescent; D002140:California; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data; D002675:Child, Preschool; D002908:Chronic Disease; D006760:Hospitalization / Q000706:statistics & numerical data*; D006782:Hospitals, Special / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data* / Q000639:trends; D007902:Length of Stay / Q000706:statistics & numerical data; D008483:Medical Assistance / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013221:State Health Plans / Q000706:statistics & numerical data