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Comparing Resource Use in Medical Admissions of Children With Complex Chronic Conditions

Jeffrey H Silber1,2,3,4,5, Paul R Rosenbaum5,6, Samuel D Pimentel7

  • 1Center for Outcomes Research, Children's Hospital of Philadelphia.

Medical Care
|July 4, 2019
PubMed

Insights

Hospitals show significant variation in resource use for children with complex chronic conditions (CCCs). Template Matching helps identify efficiency differences and target quality improvements for better patient outcomes.

Area of Science:

  • Pediatric healthcare resource utilization
  • Healthcare quality improvement
  • Complex chronic conditions management

Background:

  • Children with complex chronic conditions (CCCs) consume a significant portion of hospital resources.
  • Variations in resource utilization among hospitals for similar pediatric patients are not well understood.

Purpose of the Study:

  • To determine if hospitals exhibit significantly different resource utilization patterns when caring for similar children with CCCs.
  • To identify potential areas for quality improvement and benchmarking in pediatric healthcare.

Main Methods:

  • Utilized Pediatric Health Information System data (2009-2013) from 40 children's hospitals.
  • Constructed an inpatient "Template" of 300 children with CCCs, matched to 300 patients at each hospital for direct standardization.
  • Analyzed intensive care unit (ICU) admission rates, length of stay, and total cost per patient.

Main Results:

  • Significant variations in resource utilization were observed across hospitals.
  • Intensive care unit (ICU) utilization varied by 111%, length of stay by 25%, and total cost by 47% between the lowest and highest percentile hospitals.
  • Hospitals showed differing efficiency patterns for low-risk versus high-risk patients.

Conclusions:

  • Hospitals demonstrate substantial variability in resource use for pediatric patients with complex chronic conditions (CCCs).
  • Template Matching is a valuable tool for benchmarking hospital performance and identifying patient groups with aberrant outcomes.
  • Findings can guide quality initiatives to target specific patient populations and improve resource allocation.
Abstract

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