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The increasing proportion of adult discharges at children's hospitals, 2004-2019
Anna Q Allen1,2, Matt Hall3, Denise M Goodman4
1Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Insights
Children
Area of Science:
- Pediatric Health
- Adult Medicine
- Healthcare Management
Background:
- Medical advances increase survival for pediatric patients into adulthood.
- Transitioning to adult medical care presents challenges for these individuals.
- Children's hospitals are increasingly serving adult patients.
Purpose of the Study:
- To analyze trends in adult admissions to children's hospitals.
- To compare characteristics of adult and pediatric patients in children's hospitals.
- To assess the impact of increasing adult patient numbers on children's hospitals.
Main Methods:
- Utilized the Pediatric Health Information System (PHIS) database.
- Analyzed 8,097,081 patient encounters from 30 children's hospitals (2004-2019).
- Stratified data by patient age, payor, and hospital-level discharge rates.
Main Results:
- Adults in children's hospitals had more complex chronic conditions, higher costs, and longer stays than pediatric patients.
- Adult discharges from children's hospitals increased significantly across all adult age groups.
- The growth rate of adult discharges exceeded that of pediatric discharges.
Conclusions:
- Children's hospitals are experiencing a growing number of adult patients, particularly those with complex chronic conditions.
- This trend impacts resource allocation and care delivery within children's hospitals.
- Further research is needed to address the unique healthcare needs of adults treated in pediatric settings.
Abstract:
Significant medical advances now enable individuals with pediatric illnesses to survive into adulthood. Finding medical homes for these individuals often remains challenging. We utilized the Pediatric Health Information System to measure the variation in and growth of admissions to children's hospitals, stratified by age and payor from 2004 to 2019. We identified 8,097,081 patient encounters from 30 hospitals. Compared to children, adults discharged at children's hospitals are more likely to have a complex chronic condition, have a higher median cost, and have a longer median length of stay. Hospital-level adult discharges ranged from 1.9% to 10.1% (median 4.1%; interquartile range: 2.8%-5.4%). Significantly higher increases were seen in each adult age subgroup (18-20, 21-25, and >25 years old) compared to the pediatric age group (p < .001). The number of adults discharged from children's hospitals is increasing faster than children, impacting children's hospitals and the populations they serve.
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