title: Urban and rural patterns in emergent pediatric transfer: a call for regionalization.
abstract: BACKGROUND
  National groups call for the regionalization of health care, to direct patients with high-risk conditions to designated hospitals with greater capabilities. Currently there is limited information detailing the characteristics and specific needs of acutely ill and injured children who require transfer to another institution, especially in underserved rural communities.
  
  
  OBJECTIVE
  To determine the epidemiology of pediatric transfers from urban and rural emergency departments (EDs).
  
  
  METHODS
  We analyzed data in the National Hospital Ambulatory Medical Care Survey from 1995 to 2010. Eligible children were <18 years of age seen in a United States ED, and transferred to another hospital after initial evaluation.
  
  
  RESULTS
  Of all 283,232,058 pediatric ED visits, less than 0.5% resulted in a transfer, yielding a population-based estimate of 900,100 transfers nationally during this period. Urban and rural EDs showed similar transfer rates. Children transferred from rural EDs were older and more likely to arrive by emergency medical services than children transferred from urban EDs (12.1 vs 8.2 years of age, P < .01). Children from rural EDs were more than twice as likely to be transferred for a psychiatric indication (43.5% vs 19.5%, P < .01).
  
  
  CONCLUSIONS
  Emergency pediatric transfers are uncommon in the United States; transfer rates are similar in urban and rural settings. Rural children have additional obstacles to care, especially in access to emergency mental health services. Programs to study and implement regionalization of care should consider diverse patient populations and target improvement in coordination of care, transfer times, and outcomes.
authors.affiliation: Department of Emergency Medicine, University of California, Davis, Sacramento, California; Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California.
authors.forename: Timothy
authors.initials: T
authors.lastname: Horeczko
authors.forename: James P
authors.initials: JP
authors.lastname: Marcin
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Kahn
authors.forename: Robert E
authors.initials: RE
authors.lastname: Sapien
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008507:Medically Underserved Area; D010360:Patient Transfer / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States; D019037:Urban Health Services / Q000706:statistics & numerical data*
keywords: access to care; health disparities; mental health; policy; utilization of health services