Rural children have high rates of medical complexity

May 13 2016

Children in rural areas have high rates of medical complexity and often reside in low-income and medically underserved areas, according to researchers at the University of Alabama at Birmingham. A study published in Pediatrics examines the inpatient health care utilization of rural children as compared to nonrural children, specifically the higher cost of hospitalization and increased frequency of readmissions.

Investigators looked at patient admissions in 41 freestanding tertiary-care pediatric hospitals across the United States, where rural children account for 12 percent of all admissions. The most common admissions were for asthma, bronchiolitis and seizures. Children from rural areas are particularly vulnerable, as they often experience worse health outcomes, and higher rates of obesity and tobacco exposure, and 71 percent had at least one chronic medical condition.

"Our study highlights that children from rural areas can often have multiple chronic conditions and significant medical complexity," said Chang L. Wu, M.D., pediatric hospitalist, UAB Department of Pediatrics. "Identifying and addressing the deficiencies in the medical infrastructure faced by these children and their families will hopefully mean decreasing care burden, fewer hospitalizations and better overall health."

Rural children are more likely to live in poverty and seem to have unmet medical needs, relying on Medicaid for health care.

Delivering health care in rural communities has presented many challenges, including access to general practice physicians and subspecialty pediatrics, as well as home- and community-based services such as physical therapists and home nurses. These challenges lead to longer travel distances to access health services, especially if needing hospitalization, because children's hospitals are located in nonrural areas.

Marjorie Lee White, M.D., is a pediatric emergency medicine physician in the UAB School of Medicine Department of Pediatrics.

"During my clinical practice in Children's of Alabama's emergency department, I was struck by how many rural families I was seeing with medically complex children who were forced to drive long distances to receive specialty care and seemed to be at a breaking point," White said. "Many patients were using their last dollar to drive to Children's of Alabama."

Rural children are driven an average of 68 miles to receive health care compared to 12 miles for nonrural children. Although the children's hospitals represented in the study were present in only 24 states, rural children from all 50 states were admitted to these hospitals.

"We really want to understand the health care utilization of children from rural areas to better serve their communities," Wu said. "Understanding those who use children's hospitals is necessary to optimize integration with local services to ensure all children get well and stay healthy."

Source: University of Alabama at Birmingham