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

Jay G Berry1, Matt Hall, David E Hall

  • 1Division of General Pediatrics, Children's Hospital Boston, Boston, MA, USA. jay.berry@childrens.harvard.edu

JAMA Pediatrics
|December 26, 2012
PubMed

Insights

Hospitalized children with chronic conditions, especially those with complex needs, increasingly used more resources between 2004 and 2009. Children's hospitals need to adapt systems and payment structures for this growing patient group.

Area of Science:

  • Pediatric healthcare utilization
  • Chronic disease management in children
  • Health services research

Background:

  • Children with chronic health conditions represent a growing and resource-intensive patient population.
  • Understanding trends in inpatient resource use is crucial for healthcare planning.

Purpose of the Study:

  • To compare inpatient resource utilization trends between healthy children and those with chronic health conditions of varying medical complexity.
  • To identify changes in patient numbers, hospitalizations, days, and charges over a six-year period.

Main Methods:

  • Retrospective cohort analysis of 1,526,051 unique patients across 28 US children's hospitals from 2004-2009.
  • Patients were categorized into five chronic condition groups using 3M's Clinical Risk Group software.
  • Linear regression was used to analyze trends in patient volume, hospitalizations, hospital days, and charges.

Main Results:

  • Hospitals saw a greater increase in hospitalizations for children with chronic conditions (19.2%) compared to those without (13.7%).
  • Children with significant chronic conditions affecting multiple body systems showed the largest increase (32.5%) in resource use.
  • In 2009, this complex group accounted for 48.9% of hospital days and 53.2% of charges, with higher Medicaid utilization.

Conclusions:

  • Inpatient resource utilization by children with chronic conditions is increasing, particularly for those with complex, multi-system conditions.
  • Children's hospitals must adapt their inpatient care systems and payment models to address the needs of this expanding population.
  • Cerebral palsy and asthma were common diagnoses/comorbidities in this high-resource-use group.
Abstract

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