Date and Time
November 28, 2007
1:30 PM - 3:00 PM

Availability
Open to the public
No RSVP required

Trauma and chronic illness accounts for virtually all serious morbidity and mortality in childhood. However, as compared to adult epidemiology, these problems remain relatively rare in children. In response, the child health care system has had to rely on highly regionalized systems of specialty care in which expertise, specialized facilities, and patient volume are concentrated. These regionalized systems have been shown to be highly effective in reducing morbidity and mortality from trauma and serious chronic illness in children.

The focus of this presentation is how these regionalized systems are faring amid growing instability of health care financing in California.

This retrospective analysis of pediatric hospitalizations in CA (1999-2004) uses the public dataset from the Office of Statewide Health Planning and Development (OSHPD). We examined discharges for ages 0-19 excluding normal births, teen deliveries, and non-CA residents. Specialty care centers were designated by the state agency responsible for regionalized care. Using trauma severity scoring systems and a comprehensive list of 34 chronic conditions we examined rates and variations in hospitalization for children with trauma and chronic illness. County of residence, age, payer, gender, and race/ethnicity, proximity to referral center, and bed supply were analyzed in relation to the use of specialty care.

The analyses suggest that overall, the regionalized systems of specialty care remain intact and that the majority of children with severe trauma and chronic illness are hospitalized in regional centers. However, there is substantial variation among California counties that could not be explained by proximity or payer status. Rather, other determinants, including market forces, may be operating which could apply growing pressure on longstanding patterns of specialty referral.