Rural Health

Care quality disparities exist for children seen in urban versus rural hospitals

An Institute of Medicine report recently found that less than 10 percent of emergency departments (EDs) are equipped to handle pediatric emergencies. A new study finds that EDs at urban children's hospitals provide better care for seriously ill or injured children than rural EDs. James P. Marcin, M.D., M.P.H., of the University of California, Davis, and colleagues found that general and pediatric emergency medicine physicians provide high-quality care in children's hospitals. These hospitals may feature standardized protocols and offer specialized resources, including nursing staff and equipment, that permit these physicians to provide similar, superior care.

Conversely, the authors found that all physicians, including those trained in pediatric emergency medicine, who work in rural hospital EDs provide poorer quality care to their young patients than similarly trained physicians working in urban settings. This may be a result of limited pediatric resources at the rural hospitals or differences in the physicians' knowledge base.

The authors suggest that improving availability of pediatric resources, operational structures, and staffing at rural hospitals will bolster the care quality for the children they serve. Physicians trained in pediatric emergency medicine examined 166 charts from children seen at rural non-children's hospitals and 138 charts from urban children's hospitals from January 2000 to June 2003 for this study, which was funded in part by the Agency for Healthcare Research and Quality (HS13179).

See "Quality of care of children in the emergency department: Association with hospital setting and physician training," by Madan Dharmar, M.B.B.S., Dr. Marcin, Patrick S. Romano, M.D., M.P.H., and others in the December 2008 Journal of Pediatrics 153(6), pp. 783-789.

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