title: Pediatric Oncology Discharges With Febrile Neutropenia: Variation in Location of Care.
abstract: We examined the use of Pediatric Cancer Specialty Centers (PCSCs) over time and the length of stay (LOS) in pediatric oncology patients with a diagnosis of febrile neutropenia. PCSCs were defined as Children's Oncology Group and California Children's Services designated centers. We performed a retrospective analysis on all discharges of pediatric (0 to 18) oncology patients with febrile neutropenia in California (1983 to 2011) using the private Office of Statewide Health Planning and Development database. We examined influence of age, sex, race/ethnicity, payer, income, distance, tumor type, and complications on utilization of PCSCs and LOS (SAS 9.2). Analysis of 24,559 pediatric oncology febrile neutropenia discharges showed hospitalizations in PCSCs increasing from 48% in 1983 to 94% in 2011. The adjusted regression analysis showed decreased PCSC utilization for ages 15 to 18, Hispanic patients, and those living >40 miles away. The median PCSC LOS was 9 days compared with 7 days at a non-PCSC (P<0.0001). Discharge from a PCSC was associated with a LOS >8 days after controlling for complications. Inpatient PCSC care for febrile neutropenia in California has increased since 1983. Receiving care at a PCSC is influenced by age, tumor type, ethnicity, geography, and complications.
authors.affiliation: *Division of Pediatric Hematology and Oncology †Division of General Pediatrics ‡The Center for Policy, Outcomes and Prevention, Stanford University School of Medicine, CA.
authors.forename: Elysia
authors.initials: E
authors.lastname: Alvarez
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Chamberlain
authors.forename: Catherine
authors.initials: C
authors.lastname: Aftandilian
authors.forename: Olga
authors.initials: O
authors.lastname: Saynina
authors.forename: Paul
authors.initials: P
authors.lastname: Wise
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D044383:Black People / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D064147:Febrile Neutropenia / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009369:Neoplasms / Q000150:complications; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014195:Travel; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American