Categorizing Hospitals by Neonatal and Pediatric Diagnoses Treated

Traditional classification of children's and nonchildren's hospitals is based on physical structure and branding. We grouped hospitals with the most similar types of pediatric patients.

Retrospective analysis of 2.8 million hospitalizations in 3993 hospitals for patients 0 to 20 years in the 2019 Kids' Inpatient Database. After stratifying low-volume hospitals (greater than 100 annual admissions), we grouped the remaining hospitals using K-means clustering by case-mix of neonatal services and pediatric diagnosis diversity (DD).

Clustering distinguished 6 hospital groups. Group 1 (n = 1665 [1.6% of hospitalizations]) represented low pediatric volume hospitals (13 annual pediatric hospitalizations [IQR 3-82]). Group 2 (n = 118 hospitals [1.1% of hospitalizations]) provided no neonatal care, had low DD (12 [IQR 4-34]), and had a median age of 17 years. Group 3 (n = 1156 [19.7% of hospitalizations]) hospitals provided low-severity neonatal care with low DD (13 [IQR 7-19). Group 4 (n = 674 hospitals, [24.0% of hospitalizations]) provided moderate-severity neonatal care (2.2 [ IQR 2.1-2.4]) and increased DD (24 [ IQR 6-34]). Group 5 (n = 238 hospitals [20.5% of hospitalizations]) had a similar severity of neonatal care as group 4 (2.3 [IQR 2.1-2.5]), but 2.7 times greater DD (64 [IQR 55-77]). Group 6 (n = 142 hospitals [33.0% of hospitalizations]) had the highest-severity neonatal care (2.6 [IQR 2.3-3.1]) and the greatest DD (127 [113-140]).

Children receive inpatient care across 6 groups of hospitals, distinguished by neonatal case-mix and DD. Future studies should investigate the utility of these groups for peer comparisons with health care use and outcomes.