Characteristics of US Nonchildren’s Hospitals That Lost Pediatric Inpatient Capability, 2013–2021

OBJECTIVE: Most US children receive care at nonchildren's hospitals. Trends over the past 2 decades have revealed decreasing pediatric inpatient capabilities. This study aimed to describe the hospital characteristics associated with loss of pediatric inpatient capabilities among a national sample of US nonchildren's hospitals between 2013 and 2021. METHODS: A secondary analysis was conducted using National Pediatric Readiness Project Assessments from 2013 to 2021. Hospitals with 1 or more reported pediatric inpatient unit capability (pediatric ward, pediatric intensive care unit [PICU], nursery/neonatal intensive care unit [NICU]) in 2013 and assessment responses in 2013 and 2021 were included. Multivariable logistic regression models were used to assess associations between hospital characteristics and loss of pediatric inpatient capabilities. RESULTS: Of the 1570 included hospitals, 33.4% were urban high volume, 42.8% were nontrauma designated, and 40.9% had loss of 1 or more pediatric inpatient capability between 2013 and 2021. Multivariable analysis showed nonmetro status was associated with increased adjusted odds of pediatric ward loss (adjusted OR [aOR] 3.45; 95% CI, 2.42-4.94) and nursery/NICU loss (aOR, 2.93; 95% CI, 1.76-5.00) compared with urban high-volume hospitals. Trauma-designated hospitals had decreased adjusted odds of pediatric ward loss (aOR, 0.63; 95% CI, 0.47-0.83) and nursery/NICU loss (aOR, 0.60; 95% CI, 0.40-0.88). CONCLUSIONS: Two in 5 hospitals with pediatric inpatient capability lost 1 or more capability between 2013 and 2021. Nonmetro hospitals had higher odds of capability loss, whereas trauma-designated hospitals had lower odds, highlighting geographic and structural disparities in pediatric inpatient service sustainability. Identifying impacts of these changes is critical to ensuring equitable access.