Inpatient growth and resource use in 28 children's hospitals: a longitudinal, multi-institutional study.

OBJECTIVE To compare inpatient resource use trends for healthy children and children with chronic health conditions of varying degrees of medical complexity. DESIGN Retrospective cohort analysis. SETTING Twenty-eight US children's hospitals. PATIENTS A total of 1 526 051 unique patients hospitalized from January 1, 2004, through December 31, 2009, who were assigned to 1 of 5 chronic condition groups using 3M's Clinical Risk Group software. INTERVENTION None. MAIN OUTCOME MEASURES Trends in the number of patients, hospitalizations, hospital days, and charges analyzed with linear regression. RESULTS Between 2004 and 2009, hospitals experienced a greater increase in the number of children hospitalized with vs without a chronic condition (19.2% vs 13.7% cumulative increase, P < .001). The greatest cumulative increase (32.5%) was attributable to children with a significant chronic condition affecting 2 or more body systems, who accounted for 19.2% (n = 63 203) of patients, 27.2% (n = 111 685) of hospital discharges, 48.9% (n = 1.1 million) of hospital days, and 53.2% ($9.2 billion) of hospital charges in 2009. These children had a higher percentage of Medicaid use (56.5% vs 49.7%; P < .001) compared with children without a chronic condition. Cerebral palsy (9179 [14.6%]) and asthma (13 708 [21.8%]) were the most common primary diagnosis and comorbidity, respectively, observed among these patients. CONCLUSIONS Patients with a chronic condition increasingly used more resources in a group of children's hospitals than patients without a chronic condition. The greatest growth was observed in hospitalized children with chronic conditions affecting 2 or more body systems. Children's hospitals must ensure that their inpatient care systems and payment structures are equipped to meet the protean needs of this important population of children.

[1]  D. Strachan,et al.  International trends in admissions and drug sales for asthma. , 2006, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[2]  A. Elixhauser.  Hospital Stays for Children, 2006 , 2008 .

[3]  L. Casper,et al.  Current Population Reports Special Studies Coresident Grandparents and Grandchildren , 1999 .

[4]  J. Neff,et al.  Using Medical Billing Data to Evaluate Chronically Ill Children Over Time , 2006, The Journal of ambulatory care management.

[5]  A. Plioplys,et al.  Survival Rates Among Children With Severe Neurologic Disabilities , 1998, Southern medical journal.

[6]  D. Lollar,et al.  Health Care Needs of Children With Down Syndrome and Impact of Health System Performance on Children and Their Families , 2012, Journal of developmental and behavioral pediatrics : JDBP.

[7]  James E. Levin,et al.  How Well Can Hospital Readmission Be Predicted in a Cohort of Hospitalized Children? A Retrospective, Multicenter Study , 2009, Pediatrics.

[8]  P. Casey,et al.  Increasing Prevalence of Medically Complex Children in US Hospitals , 2010, Pediatrics.

[9]  A. Diamant,et al.  Income disparities in obesity trends among California adolescents. , 2010, American journal of public health.

[10]  L. Akinbami,et al.  Asthma prevalence, health care use, and mortality: United States, 2005-2009. , 2011, National health statistics reports.

[11]  E. Skinner,et al.  Preventive and episodic health care of inner-city children , 2005, Journal of Community Health.

[12]  M. Gomáriz,et al.  Incidence of hospitalization due to community-acquired rotavirus infection: a 12-year study (1996–2008) , 2010, Epidemiology and Infection.

[13]  Richard F. Averill,et al.  Clinical Risk Groups (CRGs): A Classification System for Risk-Adjusted Capitation-Based Payment and Health Care Management , 2004, Medical care.

[14]  L. Greenfield,et al.  Paying a premium: how patient complexity affects costs and profit margins. , 1999, Annals of surgery.

[15]  J L Freeman,et al.  Associations among hospital capacity, utilization, and mortality of US Medicare beneficiaries, controlling for sociodemographic factors. , 2000, Health services research.

[16]  Bryan L Stone,et al.  Children With Complex Chronic Conditions in Inpatient Hospital Settings in the United States , 2010, Pediatrics.

[17]  Judith Rankin,et al.  20-year survival of children born with congenital anomalies: a population-based study , 2010, The Lancet.

[18]  M. J. Paris,et al.  Attitudes of medical students and health-care professionals toward people with disabilities. , 1993, Archives of physical medicine and rehabilitation.

[19]  Dionne A. Graham,et al.  Trends in Resource Utilization by Children with Neurological Impairment in the United States Inpatient Health Care System: A Repeat Cross-Sectional Study , 2012, PLoS medicine.

[20]  D. Angus,et al.  Trends in Admissions for Pediatric Status Asthmaticus in New Jersey Over a 15-Year Period , 2010, Pediatrics.

[21]  M. Brownell,et al.  Hospitalisation rates for ambulatory care sensitive conditions for persons with and without an intellectual disability--a population perspective. , 2010, Journal of intellectual disability research : JIDR.

[22]  D. Polsky,et al.  Comparing the supply of pediatric subspecialists and child neurologists. , 2005, The Journal of pediatrics.

[23]  W. Livingood,et al.  Immunization Levels Among Inner City Children Enrolled in Subsidized Childcare , 2008, Journal of health care for the poor and underserved.

[24]  Eyal Cohen,et al.  Hospital utilization and characteristics of patients experiencing recurrent readmissions within children's hospitals. , 2011, JAMA.

[25]  D. Hall.  The care of children with medically complex chronic disease. , 2011, The Journal of pediatrics.

[26]  Michael Lawrence Barnett,et al.  Trends in physician referrals in the United States, 1999-2009. , 2012, Archives of internal medicine.

[27]  Linjie Zhang,et al.  Factors Associated with Asthma Severity in Children: A Case–Control Study , 2011, The Journal of asthma : official journal of the Association for the Care of Asthma.

[28]  D. Goodman,et al.  Adult survivors of pediatric illness: the impact on pediatric hospitals. , 2002, Pediatrics.

[29]  Eyal Cohen,et al.  Characteristics of hospitalizations for patients who use a structured clinical care program for children with medical complexity. , 2011, The Journal of pediatrics.

[30]  Kristin Myers,et al.  Profile of medical charges for children by health status group and severity level in a Washington State Health Plan. , 2004, Health services research.

[31]  A. Plioplys.  Survival rates of children with severe neurologic disabilities: a review. , 2003, Seminars in pediatric neurology.

[32]  MK Marks,et al.  Cerebral palsy: What do medical students know and believe? , 2005, Journal of paediatrics and child health.

[33]  Holly Clifton,et al.  Identifying children with lifelong chronic conditions for care coordination by using hospital discharge data. , 2010, Academic pediatrics.