322 - Consolidation of Hospital-Based Care Locations for Pediatric compared to Adult Asthma in Illinois, 2016-2022

Publication Number: 322.4108

Stephanie Yang, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Michelle Macy, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Jethel Hernandez, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Kristin Kan, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Asthma is a leading condition requiring pediatric hospitalization in the US. However, there has been a nearly 20% decrease in pediatric inpatient units in the last decade and a shift toward observation status stays. This study describes and compares the number of emergency department (ED) visits, hospital stays, and hospitals with asthma-related hospital stays and/or ED visits between children and adults in Illinois.

Objective: We hypothesize that there is a significant decrease in hospitals providing hospital-based care for pediatric asthma relative to adult care.

Design/Methods: This was a retrospective study using the Illinois Hospital Association (IHA) Comparative Health Care and Hospital Data Reporting Services. Asthma-related ED visits and hospital discharges, 2016-2022, were extracted by principal diagnosis (ICD J45.0-J45.998) and divided by age groups, children (5-17) and adults (>17). Both inpatient and observation status were included as hospital stays. Chi-squared tests were used to compare the number of (1) asthma-related ED visits, (2) asthma-related hospital stays, (3) hospitals with asthma-related hospital stays, and (4) hospitals with asthma-related ED visits between 2016 and 2022 by age groups. P-values < 0.05 were considered statistically significant.

Results: From 2016 to 2022, asthma-related pediatric ED visits decreased from 16590 to 11854, while adult ED visits decreased from 43615 to 28515 (p = < 0.001) (Figure 1). During that same period, asthma-related pediatric stays decreased from 2838 to 2400, while adult stays decreased from 8883 to 5194 (p = < 0.001) (Figure 2). The number of IL hospitals with pediatric asthma-related stays decreased from 100 to 50, while those with adult asthma-related stays decreased from 180 to 167 (p = 0.002) (Figure 3). However, there was no significant difference in the number of hospitals when comparing pediatric asthma-related ED visits (186 to 182 hospitals) and adult asthma-related ED visits (190 to 185 hospitals) (p = 1.0) (Figure 3).

Conclusion(s): The patterns observed for pediatric asthma are emblematic of the consolidation of pediatric hospital care access. The pediatric volume of asthma-related hospital stays changed proportionally less than that of adult stays, yet the number of hospitals delivering this pediatric care has halved, compared with a 7% decline for adults. On the other hand, the number of hospitals with pediatric and adult asthma ED visits remained steady. Understanding how these changes affect families seeking care is still needed and underlines an opportunity for statewide planning on how children receive definitive hospital care.

Figure 1. Comparison of Asthma-related ED Visits by Adult and Pediatric Age Group, 2016-2022
Number of asthma-related ED visits separated by pediatric (ages 5-17) and adult (>17) from 2016 to 2022. Adult asthma-related ED visits decreased significantly more than pediatric asthma-related ED visits during this period (p <0.001).

Figure 2. Comparison of Asthma-related Hospital Stays by Adult and Pediatric Age Group, 2016-2022
Number of asthma-related hospital stays separated by pediatric (ages 5-17) and adult (>17) from 2016 to 2022. Adult asthma-related stays decreased significantly more than pediatric asthma-related stays during this period (p = <0.001).

Figure 3. Comparison of Number of Hospitals with Asthma-related Hospital Stays and ED Visits by Adult and Pediatric Age Group, 2016-2022
Number of Illinois hospitals with asthma-related stays or ED visits separated by pediatric (ages 5-17) and adult (>17) from 2016 to 2022. There was a significant decrease in the number of hospitals with pediatric asthma-related stays compared to those with adult asthma-related stays (p = 0.002). No significant difference was found when comparing the change in the number of hospitals with pediatric asthma-related ED visits and adult asthma-related ED visits (p = 1.0).

Figure 1. Comparison of Asthma-related ED Visits by Adult and Pediatric Age Group, 2016-2022
Number of asthma-related ED visits separated by pediatric (ages 5-17) and adult (>17) from 2016 to 2022. Adult asthma-related ED visits decreased significantly more than pediatric asthma-related ED visits during this period (p <0.001).

Figure 2. Comparison of Asthma-related Hospital Stays by Adult and Pediatric Age Group, 2016-2022
Number of asthma-related hospital stays separated by pediatric (ages 5-17) and adult (>17) from 2016 to 2022. Adult asthma-related stays decreased significantly more than pediatric asthma-related stays during this period (p = <0.001).

Figure 3. Comparison of Number of Hospitals with Asthma-related Hospital Stays and ED Visits by Adult and Pediatric Age Group, 2016-2022
Number of Illinois hospitals with asthma-related stays or ED visits separated by pediatric (ages 5-17) and adult (>17) from 2016 to 2022. There was a significant decrease in the number of hospitals with pediatric asthma-related stays compared to those with adult asthma-related stays (p = 0.002). No significant difference was found when comparing the change in the number of hospitals with pediatric asthma-related ED visits and adult asthma-related ED visits (p = 1.0).