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Rural hospitals apparently provide competent care to the more than 20 percent of children in the United States who live in rural communities, according to a study supported in part by the Agency for Healthcare Research and Quality (HS09983). Except for children hospitalized in large metropolitan areas, the study found no differences in length of hospital stays or readmission rates for children with 19 medical and 9 surgical conditions treated at rural versus nonrural hospitals in New York and Pennsylvania. The cases studied were common childhood ailments such as asthma and appendicitis, which are frequently treated without referrals to large specialty centers.
The study, which was supported in part by the Agency for Healthcare Research and Quality (HS09983 and T32 HD07740), was led by Scott A. Lorch, M.D., M.S.C.E., of the Children's Hospital of Philadelphia. Despite these study findings, Dr. Lorch and his colleagues note that additional efforts to deregionalize pediatric care must also take into account the ability of smaller hospitals to care for sicker patients whom they currently transfer to more specialized centers.
The researchers examined the discharge records of hospitals in New York and Pennsylvania for children who were diagnosed with 1 of 19 medical conditions and those who underwent 1 of 9 surgical procedures from April 1996 to July 1998. They compared length of stay (LOS), conditional length of stay (CLOS, for management of complicated cases), odds of prolonged stay, and 21-day readmission rates for children in hospitals in large urban, suburban, moderate urban, small urban, and rural areas. After adjusting for severity of illness and other factors, rural hospitals in general had similar or improved LOS for individual conditions compared with all other hospitals in the two States, except for large urban hospitals. The addition of hospital-level variables, such as presence of a pediatric intensive care unit or average yearly number of pediatric admissions, did not change these results.
More details are in "Equivalent lengths of stay of pediatric patients hospitalized in rural and nonrural hospitals," by Dr. Lorch, Xuemei Zhang, Ph.D., Paul R. Rosenbaum, Ph.D., and others, in the October 2004 Pediatrics 114(4), available online at www.pediatrics.org.
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