Trends in Pediatric Hospitalizations Following Interfacility Transfer: 2009–2022

BACKGROUND: Pediatric care is becoming increasingly regionalized. A rise in pediatric admissions following transfer may indicate increasing pressure on health systems to accommodate pediatric care. We evaluated nationwide trends in children admitted following transfer. METHODS: We performed a retrospective repeated cross-sectional study of the Kids' Inpatient Database in 2009, 2012, 2016, 2019, and 2022. Using logistic regression, we evaluated longitudinal changes of children admitted to the hospital following transfer overall. We stratified by hospital type, medical complexity, presence of trauma, and diagnosis. We evaluated changes in costs attributed to transferred-in patients. RESULTS: Over the 13-year study period, overall admissions decreased by 61 344 per year (95% CI, -74,013 to -48,675). Admissions following transfer increased by 7714 per year (95% CI, 5339-10 090), and the likelihood of a transferred-in admission rose by 5.7% annually (95% CI, 4.7%-6.7%). The increase in transferred-in admissions was noted in all hospital types and with or without trauma. The likelihood of transferred-in admissions for children without medical complexity was greater than in children with medical complexity (6.4% per year [95% CI, 5.3%-7.6%] vs 4.2% per year [95% CI, 3.2%-5.2%]). Most diagnoses demonstrated an increase in transferred-in admissions. The share of costs for transferred-in patients increased from 17.2% in 2009 to 29.5% in 2022. CONCLUSION: Transferred-in admissions and costs increased, with greatest relative increases in rural hospitals, non-medically complex children, and select admission diagnoses. These findings highlight a growing reliance on interfacility transfer and suggest a need to bolster local pediatric capacity and regional care coordination.