title: Access to pediatric subspecialty care: a population study of pediatric rheumatology inpatients in California.
abstract: OBJECTIVE
  To examine trends in the specialty care hospitalization of pediatric rheumatology patients and determine how nonclinical factors influence access.
  
  
  METHODS
  This study used California's Office of Statewide Health Planning and Development discharge database to perform a retrospective population analysis of pediatric rheumatology hospitalizations in California between 1999 and 2007. We used logistic regression to examine the relationship between hospitalization in specialty care centers with a pediatric rheumatologist and nonclinical patient characteristics.
  
  
  RESULTS
  A total of 18,641 pediatric discharges revealed that 57% were discharged from a specialty care center with a pediatric rheumatologist. Multivariate analysis showed that the factors associated with increased utilization of specialty care centers with a pediatric rheumatologist were public insurance (odds ratio [OR] 1.62, 95% confidence interval [95% CI] 1.51-1.74; P < 0.0001), being Hispanic (OR 1.29, 95% CI 1.19-1.40; P < 0.0001) or Asian non-Hispanic (OR 1.39, 95% CI 1.26-1.54; P < 0.0001), and high pediatric rheumatology specialty care bed supply (OR 2.79, 95% CI 2.49-3.14; P < 0.0001). A decreased utilization of specialty care centers with a pediatric rheumatologist was seen for patients ages <1 year (OR 0.45, 95% CI 0.40-0.52; P < 0.0001), ages 1-4 years (OR 0.50, 95% CI 0.46-0.55; P < 0.0001), ages 5-9 years (OR 0.68, 95% CI 0.62-0.75; P < 0.0001), ages 15-18 years (OR 0.51, 95% CI 0.47-0.56; P < 0.0001), males (OR 0.75, 95% CI 0.70-0.80; P < 0.0001), and patients residing farther away from a specialty care center with a pediatric rheumatologist (OR 0.57, 95% CI 0.51-0.63; P < 0.0001).
  
  
  CONCLUSIONS
  Nonclinical factors play an increasingly important role in the hospitalization patterns of pediatric rheumatology patients in California. Understanding these factors is crucial if we are to ensure that the variation in access to care reflects clinical need.
authors.affiliation: Stanford University School of Medicine, Stanford, California 94305-6019, USA. noellep@stanford.edu
authors.forename: Noelle
authors.initials: N
authors.lastname: Pineda
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Chamberlain
authors.forename: Jia
authors.initials: J
authors.lastname: Chan
authors.forename: Michal J
authors.initials: MJ
authors.lastname: Cidon
authors.forename: Paul H
authors.initials: PH
authors.lastname: Wise
mesh_terms: D000293:Adolescent; D002140:California; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010372:Pediatrics; D012216:Rheumatic Diseases / Q000628:therapy*; D012219:Rheumatology