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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Article

Supply and Utilization of Pediatric Subspecialists in the United States

Kristin N. Ray, Debra L. Bogen, Marnie Bertolet, Christopher B. Forrest and Ateev Mehrotra
Pediatrics June 2014, 133 (6) 1061-1069; DOI: https://doi.org/10.1542/peds.2013-3466
Kristin N. Ray
aChildren’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;
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Debra L. Bogen
aChildren’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;
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Marnie Bertolet
bUniversity of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania;
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Christopher B. Forrest
cChildren’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania;
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Ateev Mehrotra
dHarvard Medical School, Boston, Massachusetts; and
eRAND Corporation, Boston, Massachusetts
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Abstract

OBJECTIVE: The wide geographic variation in pediatric subspecialty supply in the United States has been a source of concern. Whether children in areas with decreased supply receive less subspecialty care or have worse outcomes has not been adequately evaluated. Among children with special health care needs, we examined the association between pediatric subspecialty supply and subspecialty utilization, need, child disease burden, and family disease burden.

METHODS: We measured pediatric subspecialist supply as pediatric subspecialists per capita in each residential county. By using the 2009–2010 National Survey of Children With Special Health Care Needs and controlling for many potential confounders, we examined the association between quintile of pediatric subspecialty supply and parent-reported subspecialty utilization, perceived subspecialty need, and child and family disease burden.

RESULTS: County-level pediatric subspecialty supply ranged from a median of 0 (lowest quintile) to 59 (highest quintile) per 100 000 children. In adjusted results, compared with children in the highest quintile, children in the lowest quintile of supply were 4.8% less likely to report ambulatory subspecialty visits (P < .001), 5.3% less likely to perceive subspecialty care needs (P < .001), and 2.3% more likely to report emergency department visits (P = .018). There were no meaningful differences between pediatric subspecialty supply quintiles for other measures of child or family disease burden.

CONCLUSIONS: Children living in counties with the lowest supply of pediatric subspecialists had both decreased perceived need for subspecialty care and decreased utilization of subspecialists. However, the differences in supply were not associated with meaningful differences in child or family disease burden.

  • subspecialty supply
  • subspecialty need
  • access to care
  • utilization
  • children with special health care needs
  • Accepted February 19, 2014.
  • Copyright © 2014 by the American Academy of Pediatrics

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Pediatrics
Vol. 133, Issue 6
1 Jun 2014
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Supply and Utilization of Pediatric Subspecialists in the United States
Kristin N. Ray, Debra L. Bogen, Marnie Bertolet, Christopher B. Forrest, Ateev Mehrotra
Pediatrics Jun 2014, 133 (6) 1061-1069; DOI: 10.1542/peds.2013-3466

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Supply and Utilization of Pediatric Subspecialists in the United States
Kristin N. Ray, Debra L. Bogen, Marnie Bertolet, Christopher B. Forrest, Ateev Mehrotra
Pediatrics Jun 2014, 133 (6) 1061-1069; DOI: 10.1542/peds.2013-3466
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