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Pediatric Critical Care Resource Use by Children with Medical Complexity
Titus Chan1, Jonathan Rodean2, Troy Richardson2
1Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, WA.
Insights
Children with complex chronic diseases (C-CD) disproportionately use the majority of pediatric intensive care unit (ICU) resources. Focusing on this high-need population is key for improving quality and cost-effectiveness in pediatric critical care.
Area of Science:
- Pediatric critical care medicine
- Health services research
- Medical complexity
Background:
- Understanding resource utilization in pediatric intensive care units (ICUs) is crucial for optimizing healthcare delivery.
- Children admitted to ICUs exhibit varying degrees of medical complexity, influencing their healthcare needs and resource consumption.
Purpose of the Study:
- To investigate the proportionate use of critical care resources among children with different levels of medical complexity.
- To analyze resource allocation in pediatric ICUs within tertiary-care children's hospitals based on patient complexity.
Main Methods:
- Retrospective, cross-sectional study of pediatric ICU admissions from January 2012 to December 2013.
- Utilized the Pediatric Medical Complexity Algorithm to categorize patients into: no chronic disease, noncomplex chronic disease (NC-CD), and complex chronic disease (C-CD).
- Analyzed and stratified baseline demographics, hospital costs, and critical care resource use by complexity group.
Main Results:
- Over 136,000 pediatric ICU admissions were analyzed; 53% were classified as C-CD.
- Patients with C-CD demonstrated the highest ICU resource use individually and accounted for over 75% of total ICU resources at the hospital level.
- Complex chronic disease patients consumed the majority of resources including ventilation days, ICU costs, and specialized procedures, while no chronic disease and NC-CD patients used less than 25%.
Conclusions:
- Children with medical complexity are disproportionate users of critical care resources in children's hospitals.
- Targeted quality improvement and cost-effectiveness initiatives should prioritize this high-resource utilization population.
- Further research into resource management for medically complex pediatric patients is warranted.
Objectives:
To examine the proportionate use of critical care resources among children of differing medical complexity admitted to pediatric intensive care units (ICUs) in tertiary-care children's hospitals.
Study Design:
This is a retrospective, cross-sectional study of all children (<19 years of age) admitted to a pediatric ICU between January 1, 2012, and December 31, 2013, in the Pediatric Health Information Systems database. Using the Pediatric Medical Complexity Algorithm, we assigned patients to 1 of 3 categories: no chronic disease, noncomplex chronic disease (NC-CD), or complex chronic disease (C-CD). Baseline demographics, hospital costs, and critical care resource use were stratified by these groups and summarized.
Results:
Of 136 133 children with pediatric ICU admissions, 53.0% were categorized as having C-CD. At the individual-encounter level, ICU resource use was greatest among patients with C-CD compared with children with NC-CD and no chronic disease. At the hospital level, patients with C-CD accounted for more than 75% of all examined ICU resources, including ventilation days, ICU costs, extracorporeal membrane oxygenation runs, and arterial and central venous catheters. Children with a progressive condition accounted for one-half of all ICU resources. In contrast, patients with no chronic disease and NC-CD accounted for less than one-quarter of all ICU therapies.
Conclusion:
Children with medical complexity disproportionately use the majority of ICU resources in children's hospitals. Efforts to improve quality and provide cost-effective care should focus on this population.
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