To describe the current system of pediatric asthma care and identify potential options for unloading tertiary centers. 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. There were 174,239 encounters for pediatric asthma, with 26,316 admissions and 3101 transfers. About 94.4% of transfers were admitted, with median stay length 2 days (interquartile range [IQR] 1.0–3.0). About 637 hospitals saw pediatric asthma, but 58.7% never admitted these patients. Fifty-four hospitals (8.5%) regularly received transfers; these hospitals were broadly capable pediatric centers (mean pediatric hospital capability indices = 0.82, IQR: 0.64–0.89). Two hundred nine facilities (32.8%) did not regularly receive transfers but were highly capable of caring for pediatric asthma (mean condition-specific capability = 0.92, IQR: 0.85–1.00). Median distance from transferring hospitals to the nearest pediatric center was 25.7 miles (IQR: 6.45–50.15) vs 18.0 miles (IQR: 8.35–29.25) to the nearest potential receiving hospital. Mean cost of a 2-day asthma admission in receiving hospitals was $3927 (IQR: $3083–$4894) versus $3427 (IQR: $2485–$4102) in potential receivers. While nearly all acute care hospitals encounter children with asthma, more than half never admit them. Children are primarily transferred to a small subset of specialized centers, despite the existence, in many regions, of closer community hospitals with high pediatric asthma capability. In settings with long transfer distances and tertiary center crowding, a tiered system of hospital care for pediatric asthma may be feasible.

中文翻译：

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重组小儿哮喘医院转运网络的机会

描述当前的儿科哮喘护理系统并确定卸载三级中心的潜在选择。使用来自阿肯色州、佛罗里达州、肯塔基州、马里兰州、马萨诸塞州和纽约州的 2014 年住院和急诊科所有遇到的管理数据集进行回顾性横断面研究。研究参与者包括初步诊断为哮喘的 18 岁以下儿童。共有 174,239 例小儿哮喘就诊，其中 26,316 例入院，3101 例转院。约 94.4% 的转院患者被接纳，中位住院时间为 2 天（四分位距 [IQR] 1.0–3.0）。大约 637 家医院收治了小儿哮喘，但 58.7% 的医院从未收治过这些患者。54 家医院（8.5%）定期接受转运；这些医院是能力广泛的儿科中心（平均儿科医院能力指数 = 0.82，IQR：0.64–0.89）。209 个机构 (32.8%) 没有定期接受转运，但具有很强的治疗小儿哮喘的能力（平均特定病情能力 = 0.92，IQR：0.85–1.00）。从转移医院到最近的儿科中心的中位距离为 25.7 英里（IQR：6.45–50.15），而到最近的潜在接收医院的中位距离为 18.0 英里（IQR：8.35–29.25）。接收医院因哮喘入院 2 天的平均费用为 3927 美元（IQR：3083-4894 美元），而潜在接收医院的平均费用为 3427 美元（IQR：2485-4102 美元）。虽然几乎所有急症护理医院都会遇到患有哮喘的儿童，但超过一半的医院从未收治他们。尽管许多地区存在具有较高小儿哮喘治疗能力的更近的社区医院，但儿童主要被转移到一小部分专科中心。在转运距离长和三级中心拥挤的环境中，针对小儿哮喘的分级医院护理系统可能是可行的。