K. Piper2, K. J. Baxter1, I. McCarthy3, M. V. Raval5 1Emory University School Of Medicine,Division Of Pediatric Surgery,Atlanta, GA, USA 2Emory University,Rollins School Of Public Health,Atlanta, GA, USA 3Emory University,Department Of Economics,Atlanta, GA, USA 5Feinberg School Of Medicine – Northwestern University,Department Of Surgery, Division Of Pediatric Surgery, Ann & Robert H. Lurie Childen’s Hospital Of Chicago,Chicago, IL, USA
Introduction: Children’s hospitals (CH) provide high volume, specialized, and resource intense care to children. Though CH comprise less than 5% of all hospitals in the United States, they account for 40% of pediatric inpatient days and 50% of pediatric healthcare costs. Because these hospitals represent a disproportionate amount of pediatric healthcare costs, it is important to determine if the care provided by CH is justified by improved health outcomes. When using large administrative and claims data sources, the first methodological step needed to compare health outcomes is to classify hospitals as CH and non-children’s hospitals (NCH). There are currently no systematic or standardized methods for classifying hospitals. The purpose of this study was to describe a novel and reproducible hospital classification methodology.
Methods: Using data from the 2015 American Hospital Association (AHA) Survey, 4,464 hospitals were classified into four categories (Tiers A-D) based on self-reported proportion of pediatric admissions as well as presence of pediatric specific structural elements and service lines. Tier A included hospitals that only provided care to children. Tier B included non-Tier A hospitals that had key pediatric services including pediatric emergency departments, pediatric intensive care units, and neonatal intensive care units (NICU). Tier C included non-Tier B hospitals that provided limited key pediatric services. Tier D hospitals provided no key pediatric services. We then validated the classifications using publicly available data related to hospital memberships and participation in a variety of child health related programs.
Results: 51 hospitals were classified as Tier A, 228 as Tier B, 1,721 as Tier C, and 1,728 as Tier D. The majority of Tier A hospitals were members of the Children’s Hospital Association (90.2%), while half of Tier B hospitals and very few Tier C/D hospitals were members. Similar trends were observed for membership in the Children’s Oncology Group, designation as a Level 1 Pediatric Trauma Center, performance of pediatric solid organ transplantation, provision of congenital heart surgery services, designation as a level 3 or 4 NICU, and membership in the National Surgical Quality Improvement Program-Pediatric (See Table).
Conclusion: Using AHA survey data is a feasible and valid method for classifying hospitals into CH (i.e. Tier A) and NCH (i.e. Tiers B, C, and D) categories using a reproducible multi-tiered system. For specific studies and research questions, investigators may elect to consider both Tier A and Tier B hospitals as CH. Further clinical validation of this hospital classification method is needed through application to administrative data sources.
