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Pediatric hospital condition consolidation in US hospitals
Matt Hall1,2, Mitch Harris1, Jess Bettenhausen2
1Children's Hospital Association, Lenexa, Kansas, USA.
Insights
Children's hospitals (CH) manage common and specialized conditions. This study developed a method to classify conditions by commonality and hospital distribution, revealing insights into healthcare resource allocation.
Area of Science:
- Pediatric Healthcare Research
- Health Services Research
- Hospital Operations Analysis
Background:
- Children's hospitals (CH) are key centers for specialized pediatric care but also treat common conditions.
- A gap exists in understanding how hospital days are distributed across CHs and non-CHs (NCH) based on condition commonality.
- A novel method is needed to classify conditions by their ubiquity and consolidation within hospitals.
Purpose of the Study:
- To develop and apply a method for classifying pediatric inpatient conditions based on their commonality and consolidation across hospitals.
- To analyze the distribution of hospital days for different condition categories between CHs and NCHs.
Main Methods:
- Retrospective analysis of the 2022 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database.
- Calculated hospital days and used the Hospital Days Consolidation Index (HDCI) to assess condition distribution.
- Employed k-means clustering to categorize 441 conditions into four groups based on hospital days and HDCI.
Main Results:
- 54 'commodity' conditions accounted for 85.7% of hospital days, with 47.2% occurring in CHs.
- 50 highly consolidated conditions (<1% of hospital days) were predominantly treated in CHs (75.3%).
- Commodity conditions were split between NCH (52.8%) and CH (47.2%), while other conditions were more concentrated in CHs (72.7% of days).
Conclusions:
- Identified 'commodity' conditions treated widely and specialized conditions consolidated within CHs.
- The Hospital Days Consolidation Index (HDCI) provides a quantifiable measure for tracking condition consolidation.
- Findings offer insights into optimizing resource allocation and understanding the roles of CHs and NCHs.
Background And Objectives:
While children's hospitals (CH) tend to be the locus of specialized hospital care, they also care for common conditions. There is no system to understand the distribution of hospital days within CHs and non-CHs (NCH) based on how ubiquitous conditions are across hospitals. We develop a method to classify conditions based on their commonality and consolidation within hospitals.
Methods:
We performed a retrospective study of the 2022 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database, excluding normal newborns. For the 441 conditions, the volume of hospital days and the distribution of days across hospitals using the Hospital Days Consolidation Index (HDCI) were determined. Conditions were categorized into four groups based on k-means clustering of hospital days and HDCI.
Results:
There were 1.5 million hospitalizations from 123 CH and 3366 NCH. There were 54 conditions representing 85.7% of hospital days classified as Very High Days & Very Low Consolidation (i.e., commodity conditions); 47.2% of these hospital days were at a CH. At the other extreme, there were 50 conditions classified as Very Low Days & Very High Consolidation (e.g., chronic lymphocytic leukemia) representing <1% of hospital days; 75.3% at CH. Among all hospital days for commodity conditions, 52.8% were at NCH and 47.2% were at a CH. However, for the remaining condition groups, 27.3% of days were at an NCH and 72.7% at a CH.
Conclusion:
We identified commodity conditions but also conditions that are consolidated, typically within CH. Consolidation can be quantified, compared, and tracked using the HDCI.
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