Children with medical complexity (CMC) who reside in rural areas are significantly more likely to present to hospitals without dedicated pediatric services, according to a study published online Sept. 24 in JAMA Network Open.

JoAnna K. Leyenaar, M.D., Ph.D., from Children’s Hospital at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, and colleagues assessed availability of pediatric services for CMC presenting at acute care hospitals. The analysis included all-payer claims data from children living in Colorado, Massachusetts, and New Hampshire from 2012 to 2017.

The researchers identified 36,943 CMC who experienced 79,906 hospitalizations. They found that rural-residing CMC were 6.55 times more likely to present to hospitals without dedicated pediatric services and 2.03 times more likely to present to hospitals without pediatric beds compared to urban-residing CMC. There were no significant differences in interfacility transfer rates.

Rural-residing CMC had an increased risk for in-hospital mortality (rate ratio, 1.44), but when adjusting for clinical characteristics, the difference in in-hospital mortality was no longer significant. Rural-urban outcomes were not modified significantly by index hospital type, but interfacility transfer was a significant modifier of rural-urban differences in surgical safety events.

“These findings suggest that efforts are justified to ensure that all hospital types are prepared to care for CMC,” the authors write.

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