Utilization of Pediatric Cardiology Subspecialty Care in California | Journal Scan

Study Questions:

What are the trends in pediatric cardiology specialty care in California over the last 3 decades?

Methods:

A retrospective, total population analysis of pediatric congenital heart disease (CHD) patients was performed using California’s Office of Statewide Health Planning and Development unmasked database. Pediatric Cardiac Specialty Care Centers (PCSCCs) were described as centers with the capacity to provide comprehensive, coordinated pediatric cardiac care.

Results:

Over the study period of 1983 to 2011, 164,310 discharges met inclusion criterion. Discharges from PCSCCs increased from 58% to 88% over the course of the study period, and were higher for surgical admissions (96%) as compared with nonsurgical admissions (71%). Admissions with a public payer increased from 42% in 1983 to 61% in 2011. There was a decline in the pediatric CHD in-hospital death rate from 51 to 23 per 100,000 from 1983 to 2011.

Conclusions:

California’s inpatient regionalized specialty care of pediatric CHD has increased significantly since 1983. As a large proportion of discharges have public payers, regionalized care will be sensitive to changes in public policy impacting payments to hospitals providing care for this patient population.

Perspective:

This study investigated the utilization of pediatric cardiac services over a period of approximately 30 years from the early 1980s to the early 2010s. California showed an increased proportion of patients receiving care at regional centers, particularly for surgical admissions. There has been increased interest in regionalization of CHD care as studies have suggested improved surgical outcomes in higher-volume centers. In California, 16 centers were rated as Pediatric Cardiac Specialty Care Centers. With this relatively large number of centers, it is likely that not all centers would be considered high-volume surgical centers. The study did not precisely define what constituted a comprehensive center. Overall, this study confirmed trends of improving neonatal mortality, and also demonstrated the high percentage of patients covered under public health plans. The provision of cardiac care in California is therefore highly dependent on policy decisions related to allocation of funds to public health plans.

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and CHD & Pediatrics, Congenital Heart Disease, CHD & Pediatrics and Interventions, CHD & Pediatrics and Quality Improvement, Interventions and Structural Heart Disease

Keywords: Cardiac Surgical Procedures, Child, Financial Management, Health Planning, Heart Defects, Congenital, Heart Diseases, Infant Mortality, Inpatients, Pediatrics, Public Health, Public Policy, Retrospective Studies


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