title: Increased utilization of pediatric specialty care: a population study of pediatric oncology inpatients in California.
abstract: OBJECTIVE
  To examine inpatient utilization of pediatric cancer specialty centers (PCSCs) by pediatric oncology patients.
  
  
  METHODS
  We performed a retrospective (1999 to 2010) population-based analysis of oncology hospitalizations for pediatric patients aged 0 through 18 years using the California Office of Statewide Health Planning and Development database. Logistic regression examined hospitalization at 29 PCSCs and variables of age, sex, tumor type, payer, race, income, and distance to admission site.
  
  
  RESULTS
  Analysis of 103,961 pediatric oncology discharges revealed that 93% occurred at PCSCs. These sites experienced a 20% increase in pediatric oncology discharges, conversely non-PCSCs exhibited a 70% decrease (P<0.0001). Multivariate analyses revealed increased utilization with young age (odds ratio [OR], 4.58; 95% CI, 3.88-5.42), African American (OR, 1.26; 95% CI, 1.11-1.43), and middle income (OR, 1.36; 95% CI, 1.29-1.45). Decreased utilization was seen for females (OR, 0.88; 95% CI, 0.84-0.93) and Hispanics (OR, 0.72; 95% CI, 0.68-0.77). Payer and proximity were not significantly associated with change in utilization. Tumor types less likely to utilize a PCSC included germ cell, solid, and central nervous system tumors. Adolescents were >3 times less likely to be treated at a PCSC.
  
  
  CONCLUSIONS
  Inpatient pediatric oncology care in California has become increasingly regionalized with the vast majority of patients accessing PCSCs. However, variability in hospitalizations of adolescent patients and children not treated in PCSCs deserve further evaluation.
authors: *Department of Pediatrics, The Center for Policy, Outcomes and Prevention Divisions of †General Pediatrics §Pediatric Hematology and Oncology, Stanford University School of Medicine, Stanford, CA ‡Lucile Packard Children's Hospital at Stanford, Palo Alto, CA.
authors: Lisa J
authors: LJ
authors: Chamberlain
authors: Noelle
authors: N
authors: Pineda
authors: Lena
authors: L
authors: Winestone
authors: Olga
authors: O
authors: Saynina
authors: Arun
authors: A
authors: Rangaswami
authors: Michael
authors: M
authors: Link
authors: Paul H
authors: PH
authors: Wise
mesh_terms: D000293:Adolescent; D002140:California; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008495:Medical Oncology / Q000458:organization & administration; D010372:Pediatrics / Q000458:organization & administration; D012189:Retrospective Studies