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Inpatient growth and resource use in 28 children's hospitals: a longitudinal, multi-institutional study.
JAMA Pediatr. 2013 Feb; 167(2):170-7.JP

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.

Authors+Show Affiliations

Division of General Pediatrics, Children's Hospital Boston, Boston, MA, USA. jay.berry@childrens.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23266509

Citation

Berry, Jay G., et al. "Inpatient Growth and Resource Use in 28 Children's Hospitals: a Longitudinal, Multi-institutional Study." JAMA Pediatrics, vol. 167, no. 2, 2013, pp. 170-7.
Berry JG, Hall M, Hall DE, et al. Inpatient growth and resource use in 28 children's hospitals: a longitudinal, multi-institutional study. JAMA Pediatr. 2013;167(2):170-7.
Berry, J. G., Hall, M., Hall, D. E., Kuo, D. Z., Cohen, E., Agrawal, R., Mandl, K. D., Clifton, H., & Neff, J. (2013). Inpatient growth and resource use in 28 children's hospitals: a longitudinal, multi-institutional study. JAMA Pediatrics, 167(2), 170-7. https://doi.org/10.1001/jamapediatrics.2013.432
Berry JG, et al. Inpatient Growth and Resource Use in 28 Children's Hospitals: a Longitudinal, Multi-institutional Study. JAMA Pediatr. 2013;167(2):170-7. PubMed PMID: 23266509.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Inpatient growth and resource use in 28 children's hospitals: a longitudinal, multi-institutional study. AU - Berry,Jay G, AU - Hall,Matt, AU - Hall,David E, AU - Kuo,Dennis Z, AU - Cohen,Eyal, AU - Agrawal,Rishi, AU - Mandl,Kenneth D, AU - Clifton,Holly, AU - Neff,John, PY - 2012/12/26/entrez PY - 2012/12/26/pubmed PY - 2013/3/26/medline SP - 170 EP - 7 JF - JAMA pediatrics JO - JAMA Pediatr VL - 167 IS - 2 N2 - 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. SN - 2168-6211 UR - https://www.unboundmedicine.com/medline/citation/23266509/Inpatient_growth_and_resource_use_in_28_children's_hospitals:_a_longitudinal_multi_institutional_study_ L2 - https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2013.432 DB - PRIME DP - Unbound Medicine ER -