Provider density and health system facility factors and their relationship to rates of pediatric perforated appendicitis in US counties

Objective: To examine whether density of providers or health care facility factors have a significant effect on the rates of perforated appendicitis in the pediatric population. Design: A retrospective database analysis. Data were linked to the Area Resource File to determine if there was an association between perforated appendicitis and density of provider and facility factors. Setting: The National Inpatient Sample database and the Kids' Inpatient Database from 1988 to 2005. Patients: All patients included had an age at admission of younger than 18 years and were selected by International Classification of Diseases, Ninth Revision code as having perforated appendicitis (540.0 or 540.1) or acute appendicitis (540.9). Main Outcome Measure: Odds ratio of perforated appendicitis to acute appendicitis by county-level density of provider and health care facility factors. Results: The odds ratio of perforated appendicitis to acute appendicitis when stratified by quartiles of increasing density of providersandfacility-level factorswasstatistically significant only for the highest-density quartile of pediatricians (odds ratio=0.88; 95% confidence interval=0.78-0.99). Conclusions: Increasinggeographicdensity of pediatricians was associated with a decreasing trend in the odds ratio of perforated appendicitis, with a statistically significant protective effect observed in the highest-density quartile of pediatricians. Thedensity of all other provider and health care facility factors analyzed did not demonstrate a significant association with the rates of perforated appendicitis.