The Right Care No Matter Where: How Research is Improving Hospital Care for Kids in Rural Communities

Corrie McDaniel, DO grew up in Kansas and went to a school with just 100 kids from kindergarten through sixth grade. When she learned about gaps in acute care for kids in rural communities, it felt close to home – and inspired her to become a physician-researcher at Seattle Children’s Research Institute’s Center for Clinical and Translational Research. 

Now she's asking important questions about acute care across communities, hospitals and providers.

“Care often looks different at community hospitals; they may not have pediatric-specific resources and their care is often geared toward adults,” Dr. McDaniel said. “My research is looking for ways to help kids get the care they deserve, no matter where they live.”

Understanding Gaps in Care

Across the country, many hospitals are not equipped to care for children. And over the past 20 years, about 1 in 4 community hospitals that previously offered pediatric care have stopped doing so due to high costs, low pediatric volume and competing priorities.

Dr. McDaniel’s research aims to understand why some community hospitals are able to keep offering hospital-based pediatric care — and how to make sure pediatric care is accessible when children need it.

The Hospital Access and Location Ontology (HALO) Database is helping her find answers. HALO – which was built by Dr. McDaniel and her colleagues – combines 13 years of data about hospitals (like the services they offer and the number of pediatric beds) and data about communities (like population, workforce, poverty, etc.).

Having this information in one tool allows researchers to ask important questions like:

• What helps keep pediatric services in place?
• Where is care needed most?

“The solution is not necessarily for every hospital to provide pediatric services,” Dr. McDaniel said. “What we need is an intentionally integrated system, where local hospitals handle basic care, children with more complex healthcare needs are referred to regional centers and patients with the most serious healthcare needs are treated at large institutions like Seattle Children's."

Evidence-Based Guidelines and Reducing Transfers

Another part of Dr. McDaniel’s research focuses on developing, sharing and implementing evidence-based guidelines for some of the more common pediatric health concerns — like high fevers, infections and asthma — that don’t necessarily need specialized pediatric care.

For example, when a baby comes to the emergency department (ED) with a urinary tract infection (UTI), a doctor who mainly sees adults may not be as confident in identifying the best care plan for a baby. They may even recommend taking that baby to a pediatric hospital, three hours away in Seattle.

“Our data shows that 70% of kids who are transferred to Seattle for care are discharged from the hospital within 24 hours with no further treatment,” Dr. McDaniel said. “The travel and worry take a huge toll on families.”

Her team has worked with the American Academy of Pediatrics to implement guidelines on caring for babies who come to the ED with high fevers into more than 100 hospitals across the U.S. and Canada. Now they are working on similar guidelines for children under age 3 with UTIs.

“The goal is to support general hospitals with issues that they may not see very often but that are very important to get right,” Dr. McDaniel said. “The more we’re able to support hospitals with what they need to provide evidence-based care, the more confident they are in providing high quality care.”

Building a Community for Rural Providers

Even with clear guidelines in place, rural providers can still face moments of uncertainty — especially when they’re the only hospital for miles. That’s why Dr. McDaniel started Supporting Access for Rural Kids (SPARK), a network that brings together providers from rural and critical access hospitals in the Pacific Northwest to share knowledge, trade ideas and learn from one another.

Dr. McDaniel knew SPARK was making an impact when one provider shared how they stabilized a baby with a collapsing lung using a butterfly needle. A year later, a different baby came to a different hospital with the same problem — and the care team knew what to do.

“That procedure saved that baby’s life,” Dr. McDaniel said. “And that means everything.”

It’s one of the many examples of how Dr. McDaniel’s research to improve access to pediatric care doesn’t just live in a database or a medical journal.

“This research focuses on making sure that every child is getting the right antibiotic, avoiding an unnecessary transfer, and/or getting a diagnosis and care before they become critically ill,” she said. “It means your child is getting the right care, no matter where they live, and that makes all the difference.”