235 - Regional transfer rates of children with bronchiolitis: a population level study

Poster Number: 235
Publication Number: 235.2021

Background: Bronchiolitis is a common pediatric condition, but little is known about regional transfers. Addressing this knowledge gap is a first step for optimizing local community resources and support services so that children with bronchiolitis can receive safe, high-quality care in their own communities.

Objective: 1. To estimate Hospital Service Area (HSA)-level transfer rates in children with bronchiolitis < 24 months old in Upstate New York, and 2. To evaluate patterns of transfer rates based on HSA-level resources.

Design/Methods: We performed a retrospective cross-sectional study examining pediatric transfer rates across HSAs in Upstate New York from 2012-2022 using New York State’s comprehensive, all-payer database. An HSA consists of a collection of zip codes where most residents receive care from hospitals within that HSA. We used ICD-9/ICD-10 codes to identify all children < 24 months old with bronchiolitis who had an emergency department (ED) visit. We excluded ED encounters originating at children’s hospitals since transfers between children’s hospitals are uncommon. The main outcome was HSA-level transfer rates (ED to ED and/or ED to inpatient transfers), calculated as the number of bronchiolitis ED encounters transferred out of the total number of HSA bronchiolitis ED encounters. To evaluate patterns of transfer rates, we organized HSA-level transfer rates by tercile and reported HSA-level resources for each tercile (i.e. per capita acute care and non-children’s hospital pediatric beds, rural-urban designation). We then performed a linear regression analysis to identify correlation between transfer rates and terciles of resources as well as transfer rates and residence in an HSA with a children's hospital.

Results: Of 117,552 encounters for bronchiolitis, 67,169 encounters met inclusion criteria, with 748 transfers (1.1%; 95% CI 0.82-1.4). (Table 1) Table 2 shows HSA-level characteristics and resources. Transfer rates between HSAs ranged from 0.08% to 10% but we did not observe any discernible relationship between HSA resources and transfer rates. (Table 3)

Conclusion(s): In this population-based study 1.1% of all encounters for bronchiolitis resulted in a transfer, with wide variation among HSAs. Findings suggest that HSA resources are not strongly associated with transfer rates for bronchiolitis. This may indicate that HSA-level characteristics are not the main drivers of transfer decisions and other factors are more critical. Further investigations should evaluate, other HSA, hospital, ED and patient characteristics to understand variation in transfer rates for bronchiolitis.