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Trends in Hospital Resource Use for Children With Complex Chronic Conditions
Nathaniel D Bayer1, Matthew Hall2, Maria Osipovich3
1Division of Pediatric Hospital Medicine, Department of Pediatrics, Golisano Children's Hospital, University of Rochester, Rochester, New York.
JAMA Network Open
|December 2, 2025
Summary
Hospital resource use by children with complex chronic conditions (CCCs) significantly increased from 2000 to 2022, driven by those with multiple CCCs. Health systems must adapt to meet these growing inpatient care needs.
Area of Science:
- Pediatric healthcare utilization
- Chronic disease epidemiology
- Health services research
Background:
- Children with complex chronic conditions (CCCs) represent a small but resource-intensive patient group within inpatient settings.
- Understanding trends in their healthcare utilization is crucial for resource allocation and healthcare planning.
Purpose of the Study:
- To analyze national trends in hospital discharges, bed days, and charges for US children with and without CCCs between 2000 and 2022.
- To identify demographic and clinical factors associated with increased resource utilization among children with CCCs.
Main Methods:
- A retrospective, repeated cross-sectional study utilizing the Kids' Inpatient Database (KID) from 2000 to 2022.
- Analysis included children aged 0-18 years, categorizing them by the number of complex chronic conditions (CCCs) using ICD-9/10 codes.
- Trends in discharge rates, bed days, and hospital charges were assessed, along with sociodemographic and clinical characteristics.
Main Results:
- The hospital discharge rate for children with one or more CCCs increased by 24.3% from 2000 to 2022, while decreasing for those without CCCs.
- Children with multiple CCCs (2 or more) showed significant increases in discharge rates (60.9% to 340.0%).
- Children with CCCs accounted for a growing proportion of total hospital discharges (16.9% to 21.9%), bed days (32.0% to 44.1%), and charges (44.2% to 59.5%) over the study period.
Conclusions:
- National inpatient resource utilization by children with CCCs has substantially increased from 2000 to 2022, primarily driven by those with multiple conditions.
- These findings underscore the critical need for healthcare systems to enhance resources, staffing, and payment models to sustainably manage the escalating demands of inpatient care for this population.
- The increasing burden highlights the importance of integrated care models and preventative strategies for children with complex chronic conditions.
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