Pediatric Respiratory Syncytial Virus Hospitalizations and Respiratory Support After the COVID-19 Pandemic.

Importance: After the COVID-19 pandemic, there was a surge of pediatric respiratory syncytial virus (RSV) infections, but national data on hospitalization and intensive care unit use and advanced respiratory support modalities have not been reported.

Objective: To analyze demographics, respiratory support modes, and clinical outcomes of children with RSV infections at tertiary pediatric hospitals from 2017 to 2023.

Design, Setting, And Participants: This cross-sectional study evaluated children from 48 freestanding US children's hospitals registered in the Pediatric Health Information System (PHIS) database.

Patterns in hospital admissions for adults with congenital heart disease for non-cardiac procedures.

Objective: Advances in management of congenital heart disease (CHD) have led to an increasing population of adults with CHD, many of whom require non-cardiac procedures. The objectives of this study were to describe the characteristics of these patients, their distribution among different hospital categories and the characteristics determining this distribution, and mortality rates following noncardiac procedures.

Methods: We retrospectively analysed 27 state inpatient databases.

Hospital Access Patterns of Children With Technology Dependence.

Objectives: We studied hospital utilization patterns among children with technology dependence (CTD). We hypothesized that increasing pediatric healthcare concentration requires those caring for CTD to selectively navigate healthcare systems and travel greater distances for care.

Methods: Using 2017 all-encounter datasets from 6 US states, we identified CTD visits defined by presence of a tracheostomy, gastrostomy, or intraventricular shunt.

Neighborhood Poverty and Distance to Pediatric Hospital Care.

Objective: To describe the relationship between neighborhood poverty and geographic access to pediatric inpatient care.

Methods: This is a retrospective, cross-sectional study using 2017-18 hospital and demographic data, as well as geographic data from the 2010 census. Acute care hospitals in 17 states were included, comprising approximately one-third of the national population.

Patients With Congenital Heart Disease Undergoing Noncardiac Procedures at Hospitals With and Without a Cardiac Surgical Program.

Background The type and location of hospitals where patients with congenital heart disease (CHD) undergo noncardiac procedures have not been investigated. This study aimed to describe (1) the characteristics of these patients, (2) the distribution of procedures among hospitals with and without a cardiac surgical program and travel distances, (3) the characteristics determining the distribution, and (4) mortality rates. Methods and Results This is a retrospective cohort analysis of inpatient data from the Center for Healthcare Information and Analysis of the Commonwealth of Massachusetts, Texas Healthcare Information Collection, and Health Care Cost and Utilization Project State Inpatient Database.

Impact of Allocation on Survival During Intermittent Chemotherapy Shortages: A Modeling Analysis.

Background: Intermittent shortages of chemotherapeutics used to treat curable malignancies are a worldwide problem that increases patient mortality. Although multiple strategies have been proposed for managing these shortages (eg, prioritizing patients by age, scarce treatment efficacy per volume, alternative treatment efficacy difference), critical clinical dilemmas arise when selecting a management strategy and understanding its impact.

Patients And Methods: We developed a model to compare the impact of different allocation strategies on overall survival during intermittent chemotherapy shortages and tested it using vincristine, which was recently scarce for 9 months in the United States.

Supraventricular Tachycardia in Infants With Congenital Diaphragmatic Hernia: Prevalence, Associations, and Outcomes.

Objectives: To characterize the prevalence, associations, management, and outcomes of supraventricular tachycardia (SVT) in neonates with congenital diaphragmatic hernia (CDH).

Design: Retrospective chart and cardiology code review within a cohort of patients with CDH was used to define a subpopulation with atrial arrhythmia. SVT mechanisms were confirmed by electrocardiogram analysis.

Socioeconomic Disadvantage and Distance to Pediatric Critical Care.

Objectives: To describe the geography of pediatric critical care services and the relationship between poverty and distance to these services across the United States.

Design: Retrospective, cross-sectional study.

Setting: Contiguous United States.

Opportunities for Restructuring Hospital Transfer Networks for Pediatric Asthma.

Objective: To describe the current system of pediatric asthma care and identify potential options for unloading tertiary centers.

Methods: Retrospective, cross-sectional study using 2014 inpatient and emergency department all-encounter administrative datasets from Arkansas, Florida, Kentucky, Maryland, Massachusetts, and New York. Study participants included children <18 with primary diagnosis of asthma.

Availability of Inpatient Pediatric Surgery in the United States.

Background: In 2015, the American College of Surgeons began its Children's Surgery Verification Quality Improvement Program, promulgating standards intended to promote regionalization and improve pediatric surgical care. It was hypothesized that pediatric surgical care was already highly regionalized and concentrated before implementation of the program. This study aimed to demonstrate this by describing the sites and volume of nonambulatory pediatric surgery.

Trends in the Use of Noninvasive and Invasive Ventilation for Severe Asthma.

Objectives: To explore and define contemporary trends in the use of invasive mechanical ventilation (IMV) and noninvasive ventilation (NIV) in the treatment of children with asthma.

Methods: We performed a serial cross-sectional analysis using data from the Pediatric Health Information System. We examined 2014-2018 admission abstracts from patients aged 2 to 17 years who were admitted to member hospitals with a primary diagnosis of asthma.

Assessment of Acute Hospital Use and Transfers for Management of Pediatric Seizures.

Importance: The availability of pediatric hospital care for common conditions is decreasing across the US. The consequences of this decrease on access to care for specific conditions need to be evaluated.

Objective: To evaluate the degree of regionalization of pediatric seizure care in the US by characterizing the activity of hospital systems in 6 diverse states.

Visualizing Patterns in Pediatric and Adult Hospital Care.

Objectives: We aimed to design a graphical tool for understanding and effectively communicating the complex differences between pediatric and adult hospital care systems.

Patients And Methods: We analyzed the most recent hospital administrative data sets for inpatient admission and emergency department visits from 7 US states (2014: Arkansas, Florida, Kentucky, Maryland, Massachusetts, and New York; 2011: California). Probabilities of care completion (Pcc) were calculated for pediatric (<18 years old) and adult conditions in all acute-care hospitals in each state.

Outcomes of Hospital Transfers for Pediatric Abdominal Pain and Appendicitis.

Importance: Hospital care for children is becoming more concentrated, with interhospital transfer occurring more frequently even for common conditions. Condition-specific analysis is required to determine the value, costs, and consequences of this trend.

Objectives: To describe the capabilities of transferring and receiving hospitals and to determine how often children transferred after an initial diagnosis of abdominal pain or appendicitis require higher levels of care.

Frequency, trends, and antecedents of severe maternal depression after three million U.S. births.

Background: Postpartum depression carries adverse consequences for mothers and children, so widespread screening during primary care visits is recommended. However, the rates, timing, and factors associated with significant depressive episodes are incompletely understood.

Methods And Findings: We examined the Healthcare Cost and Utilization Project (HCUP) State Inpatient, Emergency Department, and Ambulatory Surgery and Services Databases from California (2005-2011) and Florida (2005-2012).

Pediatric Specialty Care Model for Management of Chronic Respiratory Failure: Cost and Savings Implications and Misalignment With Payment Models.

Objective: To describe program design, costs, and savings implications of a critical care-based care coordination model for medically complex children with chronic respiratory failure.

Design: All program activities and resultant clinical outcomes were tracked over 4 years using an adapted version of the Care Coordination Measurement Tool. Patient characteristics, program activity, and acute care resource utilization were prospectively documented in the adapted version of the Care Coordination Measurement Tool and retrospectively cross-validated with hospital billing data.

Trends in Regionalization of Hospital Care for Common Pediatric Conditions.

Objectives: We have previously observed that hospital care for children is concentrating significantly in Massachusetts. We now extend those observations to include 4 US states and give closer attention to the management patterns of specific clinical conditions.

Methods: We used inpatient and emergency department administrative data sets from California, Florida, Massachusetts, and New York to measure transfer frequency and identify the site of care completion for >252 million hospital encounters from 2006 through 2013.

Availability of Definitive Hospital Care for Children.

Importance: Timely and efficient access to hospital care is essential for the health and well-being of children. As insurance networks, accountable care organizations, and alternative payment methods evolve, these new systems of care must continue to serve the needs of children.

Objective: To test the hypothesis that the availability of definitive pediatric hospital care is significantly more limited than adult care and is decreasing disproportionately.

Chronic respiratory failure: Utilization of a pediatric specialty integrated care program.

Objective: Describe utilization and satisfaction in a specialty integrated care program for children with severe, chronic respiratory insufficiency (CRI).

Subjects: Enrollees of the Critical Care, Anesthesia, Perioperative Extension (CAPE) and Home Ventilation Program.

Methods: Children with CRI received home visits, care coordination, and "on-demand" 24/7 access to physicians.

Transfer Frequency as a Measure of Hospital Capability and Regionalization.

Objective: To provide metrics for quantifying the capability of hospitals and the degree of care regionalization.

Data Source: Administrative database covering more than 10 million hospital encounters during a 3-year period (2012-2014) in Massachusetts.

Principal Findings: We calculated the condition-specific probabilities of transfer for all acute care hospitals in Massachusetts and devised two new metrics, the Hospital Capability Index (HCI) and the Regionalization Index (RI), for analyzing hospital systems.