Dataset Information

Inpatient growth and resource use in 28 children's hospitals: a longitudinal, multi-institutional study.

ABSTRACT:

Objective

To compare inpatient resource use trends for healthy children and children with chronic health conditions of varying degrees of medical complexity.

Design

Retrospective cohort analysis.

Setting

Twenty-eight US children's hospitals.

Patients

A total of 1 526 051 unique patients hospitalized from January 1, 2004, through December 31, 2009, who were assigned to 1 of 5 chronic condition groups using 3M's Clinical Risk Group software.

Intervention

None.

Main outcome measures

Trends in the number of patients, hospitalizations, hospital days, and charges analyzed with linear regression.

Results

Between 2004 and 2009, hospitals experienced a greater increase in the number of children hospitalized with vs without a chronic condition (19.2% vs 13.7% cumulative increase, P < .001). The greatest cumulative increase (32.5%) was attributable to children with a significant chronic condition affecting 2 or more body systems, who accounted for 19.2% (n = 63 203) of patients, 27.2% (n = 111 685) of hospital discharges, 48.9% (n = 1.1 million) of hospital days, and 53.2% ($9.2 billion) of hospital charges in 2009. These children had a higher percentage of Medicaid use (56.5% vs 49.7%; P < .001) compared with children without a chronic condition. Cerebral palsy (9179 [14.6%]) and asthma (13 708 [21.8%]) were the most common primary diagnosis and comorbidity, respectively, observed among these patients.

Conclusions

Patients with a chronic condition increasingly used more resources in a group of children's hospitals than patients without a chronic condition. The greatest growth was observed in hospitalized children with chronic conditions affecting 2 or more body systems. Children's hospitals must ensure that their inpatient care systems and payment structures are equipped to meet the protean needs of this important population of children.

SUBMITTER: Berry JG

PROVIDER: S-EPMC3663043 | biostudies-literature | 2013 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Inpatient growth and resource use in 28 children's hospitals: a longitudinal, multi-institutional study.

Berry Jay G JG Hall Matt M Hall David E DE Kuo Dennis Z DZ Cohen Eyal E Agrawal Rishi R Mandl Kenneth D KD Clifton Holly H Neff John J

JAMA pediatrics 20130201 2

<h4>Objective</h4>To compare inpatient resource use trends for healthy children and children with chronic health conditions of varying degrees of medical complexity.<h4>Design</h4>Retrospective cohort analysis.<h4>Setting</h4>Twenty-eight US children's hospitals.<h4>Patients</h4>A total of 1 526 051 unique patients hospitalized from January 1, 2004, through December 31, 2009, who were assigned to 1 of 5 chronic condition groups using 3M's Clinical Risk Group software.<h4>Intervention</h4>None.<h ...[more]

PMID: 23266509

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Project description:BACKGROUND:Hospital charges and lengths of stay may be greater when adults with chronic conditions are admitted to children's hospitals. Despite multiple efforts to improve pediatric-adult healthcare transitions, little guidance exists for transitioning inpatient care. OBJECTIVE:This study sought to characterize pediatricadult inpatient care transitions across general pediatric services at US children's hospitals. DESIGN, SETTING AND PARTICIPANTS:National survey of inpatient general pediatric service leaders at US children's hospitals from January 2016 to July 2016. MEASUREMENTS:Questionnaires assessed institutional characteristics, presence of inpatient transition initiatives (having specific process and/or leader), and 22 inpatient transition activities. Scales of highly correlated activities were created using exploratory factor analysis. Logistic regression identified associations between institutional characteristics, transition activities, and presence of an inpatient transition initiative. RESULTS:Ninety-six of 195 children's hospitals responded (49.2% response rate). Transition initiatives were present at 38% of children's hospitals, more often when there were dual-trained internal medicine-pediatrics providers or outpatient transition processes. Specific activities were infrequent and varied widely from 2.1% (systems to track youth in transition) to 40.5% (addressing potential insurance problems). Institutions with initiatives more often consistently performed the majority of activities, including using checklists and creating patient-centered transition care plans. Of remaining activities, half involved transition planning, the essential step between readiness and transfer. CONCLUSIONS:Relatively few inpatient general pediatric services at US children's hospitals have leaders or dedicated processes to shepherd transitions to adultoriented inpatient care. Across institutions, there is a wide variability in performance of activities to facilitate this transition. Feasible process and outcome measures are needed.

Dataset Information

Inpatient growth and resource use in 28 children's hospitals: a longitudinal, multi-institutional study.

Objective

Design

Setting

Patients

Intervention

Main outcome measures

Results

Conclusions

Publications

Inpatient growth and resource use in 28 children's hospitals: a longitudinal, multi-institutional study.

Similar Datasets

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