HD53 - Study of Pediatric Health Care in Virginia Pursuant to SJR 127/HJR 180

Executive Summary:
Policy makers, health care professionals, and concerned citizens are continuing to grapple with ways to measure and improve the health status of the Commonwealth's children. To do so effectively, timely and accurate information about the health status of children is essential. Unfortunately, in the past such information was not widely available. This study has as its purpose to discover why some of Virginia's localities have higher incidence rates for pediatric hospitalizations than others do, and to explore how the quality of pediatric care should be measured and reported in Virginia.

The study presents findings from an analysis of both quantitative and qualitative factors associated with child and adolescent hospitalizations in Virginia. The study is unique in that it combines three types of data: key informant interviews, quantitative analyses, and expert opinions. This three-tier approach provides a uniquely comprehensive and in-depth method for examining child and adolescent health in the Commonwealth. The following sections summarize major findings from the study.

Quantitative Analysis

Sixteen of the most frequent and expensive reasons for Virginia's children to be admitted to hospitals are: unintentional injuries, depression, vaginal delivery, asthma, manic depression, bronchiolitis/bronchitis, pneumonia, behavior disorders, cesarean delivery, gastroenteritis, dehydration, assault, viral illness, diabetes, self-inflicted injuries, and substance abuse.

These reasons were clustered into five groups: Acute, Chronic, Mental Health, Delivery, and Injury. For each group, the following community characteristics were studied: hospital beds per 1,000 population, per capita income, percent female, percent black, percent uninsured, percent with Medicaid, fiscal stress index, percent population less than 19 years old, extreme prematurity, and percent urban.

The results of this analysis show that the number of hospital beds per 1,000 population and percent of Medicaid users tend to predict the discharge rates in the models. Extreme prematurity was also a consistent predictor of the various discharge rates.

Key informant Interviews

Key informants reported that the variations in hospitalizations could likely be explained by understanding physicians' admitting practices and the family's care-seeking behavior. There was also consensus that parents may delay care due to lack of knowledge, denial of mental health and substance abuse problems, frustration or lack of trust in providers. Suggestions for decreasing hospitalization were offered. These included improving access in the community, increasing the availability of community-based mental health services, expanding case management services and educating families and health professionals.

Expert Panel

Participants of the expert panel agreed that information about pediatric healthcare should be regularly reporting within the Commonwealth. The group also agreed that since the reasons for admissions vary, i.e., public health, mental health, and acute health, data for this report should be supplied from state agencies who oversight responsibility. The suggested process is first to define desired outcomes, then to determine what data are needed to measure the outcomes, using existing data if possible. Finally, the expert panel suggested tracking the data over time in order to identify any changes.


This analysis represents a first step in determining the optimal method to measure the quality of care for Virginia's children. The report shows the types of indicators needed to monitor pediatric care in Virginia. These indicators should include information about: (a) pediatric medical and economic access, (b) the quality of pediatric outcomes and (c) the impact that specific interventions may have on enhancing individuals' propensity to seek care. Further efforts are needed to develop and test these measurement indicators.


Based on this analysis the following recommendations are made:

• Virginia's Joint Commission on Health Care consider supporting action that will grant an existing state agency or organization the responsibility and funding to regularly report information about the frequency, nature, cause and quality of pediatric hospital admissions in the Commonwealth.

• That the authority granted to discharge these responsibilities span state agency boundaries so that the necessary data may be easily acquired to develop the optimal measurement indicators.

• The information be widely disseminated to consumers and providers of healthcare, advocates and the various oversight bodies.

• A mechanism to evaluate the use and value of the information be developed.