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Pediatric high users of Canadian hospitals and emergency departments
Ryan Tiller1, Kevin Chan2,3, John C Knight1,4
1Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
Insights
Frequent pediatric hospital and emergency department (ED) users in Canada are a distinct group with specific demographic and clinical characteristics. Understanding these high-use pediatric patients is crucial for improving healthcare planning and targeted interventions.
Area of Science:
- Pediatric healthcare utilization
- Health services research
- Public health
Background:
- Limited research exists on the characteristics of frequent pediatric users of hospital services.
- Identifying high-use pediatric patients is essential for effective healthcare resource allocation and service planning.
Purpose of the Study:
- To determine the clinical diagnoses, demographic characteristics, and medical severity of high-use pediatric patients in Canada.
- To characterize frequent users of hospital and emergency department (ED) services among children.
Main Methods:
- Retrospective analysis of pediatric patients (<18 years) using the Canadian Institute for Health Information's (CIHI) Dynamic Cohort of Complex, High System Users.
- Inclusion of hospital admission data (excluding Quebec and Manitoba) and ED data (Alberta and Ontario).
Main Results:
- 121,104 frequent hospital users and 459,998 frequent ED users were identified.
- High users were more likely to be from rural communities, lower income quintiles, and experience greater deprivation.
- Common hospitalizations included prematurity/fetal growth disorders, perinatal respiratory/cardiovascular issues, and neonatal hematological disorders. Frequent ED diagnoses included upper respiratory infections, head injuries, and middle ear diseases.
Conclusions:
- Frequent pediatric hospital and ED users represent a unique population requiring tailored healthcare strategies.
- Understanding these distinct characteristics aids in planning children's health services and implementing targeted preventive or quality improvement initiatives.
Introduction:
Few studies have examined the most frequent pediatric users of hospital services. Our objective was to determine the clinical diagnoses, demographic characteristics, and medical severity of high-use pediatric patients in Canada.
Methods:
We conducted a retrospective analysis of patients <18 years of age who either were admitted to hospital or visited an emergency department (ED) using the Canadian Institute for Health Information's (CIHI) Dynamic Cohort of Complex, High System Users. The analysis of hospital admission data excluded Quebec and Manitoba. ED data was only available for Alberta and Ontario.
Results:
121 104 patients were identified as the most frequent hospital users and 459 998 patients as the most frequent ED users. High users were more likely to reside in a rural community, to be in a lower income quintile, and face more deprivation. The most frequent conditions for hospitalization for high use patients were disorders related to length of prematurity and fetal growth, respiratory and cardiovascular disorders specific to the perinatal period, and haemorrhagic and haematological disorders of fetus and newborn. For the most frequent ED users, the most common clinical diagnoses were acute upper respiratory infections, injuries to the head, and diseases of the middle ear and mastoid.
Conclusion:
Pediatric high users by frequency of hospital and ED services are a distinct population. Better understanding their characteristics will allow for more appropriate planning of children's health services and help identify areas for effective preventive or quality improvement initiatives.
