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What Types of Hospitals Do Adolescents and Young Adults With Complex Chronic Conditions Use?
Ashley M Jenkins1, Jay G Berry2, James M Perrin3
1Division of Hospital Medicine (AM Jenkins, K Auger), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Internal Medicine (AM Jenkins), University of Cincinnati Medical Center, Cincinnati, OH.
Insights
Hospitalizations for adolescents and young adults (AYA) with complex chronic conditions (CCC) shift from pediatric to adult hospitals as they age. Older AYAs with CCCs are more likely to be treated in adult facilities, highlighting care transition challenges.
Area of Science:
- Pediatric Healthcare
- Adolescent Medicine
- Chronic Disease Management
Background:
- Hospitalizations for children with complex chronic conditions (CCC) at pediatric hospitals have increased.
- Understanding hospital utilization by adolescents and young adults (AYA) with CCCs across different hospital types is limited.
Purpose of the Study:
- To assess the types of hospitals utilized by AYAs (ages 15-30) with CCCs.
- To analyze age-related trends in hospital type selection for AYAs with CCCs.
Main Methods:
- Cross-sectional study of 856,120 hospitalizations for AYAs (15-30 years) with ≥1 CCC using the 2017 National Inpatient Sample.
- Identification of AYAs with CCCs via ICD-10-CM codes and the pediatric CCC classification system.
- Analysis of hospital types: pediatric, adult with pediatric services, and adult without pediatric services.
Main Results:
- A significant shift in hospital use occurs between ages 15-20 and 21-30.
- For AYAs aged 15-20, 39.7% of discharges were from pediatric hospitals; this dropped to 1.0% for AYAs aged 21-30.
- Older AYAs (21-30) predominantly used adult hospitals without pediatric services (65.6%).
Conclusions:
- Most AYAs (≥21 years) with CCCs are discharged from adult hospitals without pediatric services.
- Older AYAs treated in pediatric hospitals showed higher technology dependence and more complex CCCs.
- Care needs and transition challenges may explain the continued use of pediatric settings by some older AYAs with CCCs.
Background And Objective:
Hospitalizations for children with complex chronic conditions (CCC) at pediatric hospitals have risen over time. Little is known about what hospital types, pediatric or adult, adolescents, and young adults (AYA) with CCCs use. We assessed the types of hospitals used by AYAs with CCCs.
Methods:
We performed a cross-sectional study of 856,120 hospitalizations for AYAs ages 15-to-30 years with ≥1 CCC in the 2017 National Inpatient Sample. We identified AYA with CCC by ICD-10-CM diagnosis codes using the pediatric CCC classification system version 2. Hospital types included pediatric hospitals (n = 70), adult hospitals with pediatric services (n = 277), and adult hospitals without pediatric services (n = 3975). We analyzed age trends by hospital type and CCC count in 1-year intervals and dichotomously (15-20 vs 21-30 years) with the Cochran-Armitage test.
Results:
The largest change in pediatric hospitals used by AYA with CCCs occurred between 15 and 20 years with 39.7% versus 7.7% of discharges respectively (P< 0.001). For older AYA (21 to 30 years), 1.0% of discharges occurred at pediatric hospitals, compared with 65.6% at adult hospitals without pediatric services (P < 0.001). Older AYA at pediatric hospitals had more technology dependence (42.5%) versus younger AYA (27.6%, p < 0.001).
Conclusions:
Most discharges for AYAs ≥21 years with CCCs were from adult hospitals without pediatric services. Higher prevalence of technology dependence and neuromuscular CCCs, as well as multiple CCCs, for AYA 21-to-30 years discharged from pediatric hospitals may be related to specific care needs only found in pediatric settings and challenges transferring into adult hospital care.
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