Aligning Inpatient Pediatric Research With Settings of Care: A Call to Action

* Abbreviations: KID — : Kids’ Inpatient Database QI — : quality improvement Hospital-based pediatric care occurs in structurally diverse settings, ranging from large freestanding children’s hospitals to small rural community hospitals. Although there has been a recent trend toward increasingly regionalized pediatric care,1 the majority of pediatric patients are still cared for in nonchildren’s hospitals.2 A recent study revealed that less than one-third of all pediatric hospitalizations in the United States occur at freestanding children’s hospitals.2 In contrast, more than half of hospitalizations for children are estimated to occur in community hospitals,2 which we define as general hospitals that are neither freestanding nor nested children’s hospitals that admit children to licensed pediatric beds. Currently the majority of pediatric research funded by the National Institutes of Health originates at a relatively small number of children’s hospitals,3 and the creators of a national initiative to establish pediatric inpatient research priorities used data that exclusively represented patients cared for at freestanding children’s hospitals.4 The absence of community-hospital representation in the research arena leaves questions that may be the most pertinent to clinical care in these hospitals both unasked and unanswered. Because of heterogeneity of patient volumes, diverse practice settings, and often limited access to pediatric-specific resources in community hospitals, clinical guidelines and quality improvement (QI) recommendations derived from research conducted at children’s hospitals may not be directly applicable in … Address correspondence to Corrie E. McDaniel, DO, Department of Pediatrics, Seattle Children’s Hospital, 4800 Sandpoint Way NE, Mailstop FA.2.115, PO Box 5371, Seattle, WA 98105. E-mail: corrie.mcdaniel{at}seattlechildrens.org