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Increased Utilization of Pediatric Specialty Care: A Population Study of Pediatric Oncology Inpatients in California

Chamberlain, Lisa J. MD, MPH; Pineda, Noelle BA; Winestone, Lena MD; Saynina, Olga MA; Rangaswami, Arun MD; Link, Michael MD; Wise, Paul H. MD, MPH

Journal of Pediatric Hematology/Oncology: March 2014 - Volume 36 - Issue 2 - p 99–107
doi: 10.1097/01.mph.0000438027.07467.f1
Original Articles

Objective: To examine inpatient utilization of pediatric cancer specialty centers (PCSCs) by pediatric oncology patients.

Study Design: We performed a retrospective (1999 to 2010) population-based analysis of oncology hospitalizations for pediatric patients aged 0 through 18 years using the California Office of Statewide Health Planning and Development database. Logistic regression examined hospitalization at 29 PCSCs and variables of age, sex, tumor type, payer, race, income, and distance to admission site.

Results: Analysis of 103,961 pediatric oncology discharges revealed that 93% occurred at PCSCs. These sites experienced a 20% increase in pediatric oncology discharges, conversely non-PCSCs exhibited a 70% decrease (P<0.0001). Multivariate analyses revealed increased utilization with young age (odds ratio [OR], 4.58; 95% CI, 3.88-5.42), African American (OR, 1.26; 95% CI, 1.11-1.43), and middle income (OR, 1.36; 95% CI, 1.29-1.45). Decreased utilization was seen for females (OR, 0.88; 95% CI, 0.84-0.93) and Hispanics (OR, 0.72; 95% CI, 0.68-0.77). Payer and proximity were not significantly associated with change in utilization. Tumor types less likely to utilize a PCSC included germ cell, solid, and central nervous system tumors. Adolescents were >3 times less likely to be treated at a PCSC.

Conclusions: Inpatient pediatric oncology care in California has become increasingly regionalized with the vast majority of patients accessing PCSCs. However, variability in hospitalizations of adolescent patients and children not treated in PCSCs deserve further evaluation.

*Department of Pediatrics, The Center for Policy, Outcomes and Prevention

Divisions of General Pediatrics

§Pediatric Hematology and Oncology, Stanford University School of Medicine, Stanford, CA

Lucile Packard Children’s Hospital at Stanford, Palo Alto, CA

Supported by the California Health Care Foundation and the Lucile Packard Foundation for Children’s Health.

The authors declare no conflict of interest.

Reprints: Lisa J. Chamberlain, MD, MPH, Division of General Pediatrics, Stanford University School of Medicine, 770 Welch Rd. MC 5781, Ste 100, Palo Alto, 94304 CA (e-mail: lchamberlain@lpch.org).

Received October 19, 2012

Accepted August 12, 2013

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.