Inpatient Growth and Resource Use in 28 Children's Hospitals

Authors:
  • MHMatt Hall
    Matt Hall
  • DHDavid E. Hall
    David E. Hall
  • DKDennis Z. Kuo
    Dennis Z. Kuo
  • ECEyal Cohen
    Eyal Cohen
  • RARishi Agrawal
    Rishi Agrawal
  • KMKenneth D. Mandl
    Kenneth D. Mandl
  • HCHolly Clifton
    Holly Clifton
  • JNJohn Neff
    John Neff
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Abstract
ObjectiveTo compare inpatient resource use trends for healthy children and children with chronic health conditions of varying degrees of medical complexity.DesignRetrospective cohort analysis.SettingTwenty-eight US children's hospitals.PatientsA 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.InterventionNone.Main Outcome MeasuresTrends in the number of patients, hospitalizations, hospital days, and charges analyzed with linear regression.ResultsBetween 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.ConclusionsPatients 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.

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