Long length of hospital stay in children with medical complexity

Area of Science:

• Pediatric healthcare utilization
• Hospital management and efficiency
• Complex chronic conditions in children

Background:

• Children with medical complexity (CMC) utilize a disproportionate amount of hospital resources, with longer lengths of stay (LOS) compared to their peers.
• Understanding the factors contributing to prolonged hospitalizations in CMC is crucial for optimizing care and resource allocation.

Purpose of the Study:

• To evaluate the impact and identify risk factors associated with long lengths of stay (LOS) of 10 days or more for children with medical complexity (CMC).
• To assess the variation in long LOS hospitalizations for CMC across different children's hospitals.

Main Methods:

• A retrospective analysis of 954,018 hospitalizations for CMC between 2013-2014 across 44 children's hospitals.
• Utilized 3M's Clinical Risk Group categories to identify CMC and employed multivariable regression to determine factors linked to LOS ≥10 days.
• Compared hospital-level, risk-adjusted rates of long LOS using covariance testing.

Main Results:

• Long LOS hospitalizations (≥10 days) represented 14.9% of CMC admissions and incurred 61.8% of total hospital costs ($13.7 billion).
• Key factors associated with long LOS included intensive care unit (ICU) use (OR: 3.5), respiratory complex chronic conditions (OR: 2.7), and inter-facility transfers (OR: 2.1).
• Significant variation in the prevalence of long LOS for CMC was observed across hospitals (10.3%-21.8%), even after adjusting for severity.

Conclusions:

• Prolonged hospitalizations for CMC represent a substantial financial burden on the healthcare system.
• The prevalence of long LOS in CMC is influenced by specific chronic conditions and varies significantly among children's hospitals.
• Targeting interventions to reduce prolonged LOS in CMC could lead to significant cost savings in pediatric hospital care.