43 Far from Home: The Impact of Geographic Distance from Tertiary Paediatric Hospitals on Family Expenses and Experiences
Bibliographic record
Abstract
Abstract Background Many individuals living in rural and remote communities are required to travel to urban centres to receive essential health care. These experiences may be especially complex for children and their families. Despite this, there is a lack of available literature on the experiences of children and families travelling to receive care at tertiary paediatric hospitals in Canada, specifically regarding associated costs and psychosocial impacts. 1.Objectives: Analyze tertiary hospital-based administrative data to quantify the number of admissions and length-of-stay for families living > 50 km from the hospital. 2.Describe the costs and psychosocial impacts of hospitalization on families living > 50 km from the hospital. Design/Methods Ethics approval was obtained. Family partners were involved in all aspects of the study design. We obtained a de-identified data set describing the length of stay and home community of paediatric patients admitted to our paediatrics unit. Descriptive statistics were produced to determine the relevant study population and inform subsequent data analyses. A cross-sectional survey was distributed to interested caregivers admitted to our paediatrics team. Participants were offered a $20 gift card as remuneration. The survey included optional questions to assess participant demographics, costs associated with hospitalization, and subjective stress levels. Descriptive statistics were reported. Results Administrative data analysis described 2,758 admissions to a paediatric tertiary hospital from January 1, 2021 to December 31, 2021. Patients from rural and remote communities were 9.54% of total admissions. Regression models found a strong statistical relationship between length of stay and distance from the tertiary centre (Pearson chi2 coefficient 58.9, p < 0.001). A total of 39 caregivers filled out the cross-sectional survey. 75% (n=29) of participants were from local communities and 25% (n=10) were from rural and remote communities. 82% (n=32) of hospital stays were unplanned. 54% (n=21) of participants paid out-of-pocket transportation costs and 13% (n=5) paid out-of-pocket accommodation costs. 82% (n=32) of participants had co-travellers. 20% (n=8) of participants reported difficulty paying for hospital-associated costs and 10% (n=4) had to borrow money to do so. Conclusion To our knowledge, this study is the first to look at the psychological and socioeconomic barriers facing families travelling to a tertiary paediatric hospital in Canada. Patients from outside the local area had increased odds of longer length of stay and participants described a variety of stressors associated with hospitalization. We hope to translate this data into evidence-based interventions to better support these families.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".