Access to pediatric subspecialty care: A population study of pediatric rheumatology inpatients in California
Version of Record online: 29 JUN 2011
Copyright © 2011 by the American College of Rheumatology
Arthritis Care & Research
Volume 63, Issue 7, pages 998–1005, July 2011
How to Cite
Pineda, N., Chamberlain, L. J., Chan, J., Cidon, M. J. and Wise, P. H. (2011), Access to pediatric subspecialty care: A population study of pediatric rheumatology inpatients in California. Arthritis Care Res, 63: 998–1005. doi: 10.1002/acr.20458
- Issue online: 29 JUN 2011
- Version of Record online: 29 JUN 2011
- Accepted manuscript online: 25 FEB 2011 11:15AM EST
- Manuscript Accepted: 10 FEB 2011
- Manuscript Received: 17 JUN 2010
- Lucile Packard Foundation for Children's Health award
To examine trends in the specialty care hospitalization of pediatric rheumatology patients and determine how nonclinical factors influence access.
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.
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).
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.