%0 Journal Article
%T Do pediatric hospitalizations have a unique geography?
%A Mark F Guagliardo
%A Kathleen A Jablonski
%A Jill G Joseph
%A David C Goodman
%J BMC Health Services Research
%D 2004
%I BioMed Central
%R 10.1186/1472-6963-4-2
%X This article assesses the need for a unique system of HSAs to support pediatric small-area analyses. It is a cross-sectional analysis of California hospital discharges for two age groups ¨C non-newborns 0¨C17 years old, and seniors. The measure of interest was index of localization, which is the percentage of HSA residents hospitalized in their home HSA. Indices were computed separately for each age group, and index agreement was assessed for 219 of the state's HSAs. We examined the effect of local pediatric inpatient volume and pediatric inpatient resources on the divergence of the age group indices. We also created a new system of HSAs based solely on pediatric patient origins, and visually compared maps of the traditional and the new system.The mean localization index for pediatric discharges was 20 percentage points lower than for Medicare cases, indicating a poorer fit of the traditional geographic system for children. The volume of pediatric cases did not appear to be associated with the magnitude of index divergence between the two age groups. Pediatric medical and surgical case subgroups gave very similar results, and both groups differed substantially from seniors. Location of children's hospitals and local pediatric bed supply were associated with Medicare-pediatric divergence. There was little visual correspondence between the maps of traditional and pediatric-specific HSAs.Children and seniors have significantly different geographic patterns of hospitalization in California. Medicare-based HSAs may not be appropriate for all age groups and service types throughout the U.S.Studies of regional variation in child health care have identified differences in the supply of medical care resources and in the use of these resources in relation to population need [1-9]. Although small area analysis [10] is the most widely used method for studying regional variation in child health services, relatively few pediatric studies [2,3,6,8,9] have been published in contrast
%U http://www.biomedcentral.com/1472-6963/4/2