82 - Longitudinal Hospitalization Trends of Children with Complex Conditions at Children’s Hospitals
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 82 Publication Number: 82.305
Jeffrey D. Colvin, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; S Margaret Wright, Children's Mercy Kansas City, Kansas City, MO, United States; Emily J. Goodwin, Children's Mercy Kansas City, Kansas City, MO, United States; Jodi Dickmeyer, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; Matt Hall, Children's Hospital Association, Lenexa, KS, United States
Director of Research, General Academic Pediatrics Children's Mercy Hospitals and Clinics Kansas City, Missouri, United States
Background: Children with medical complexity (CMC) have one or more complex chronic conditions (CCC). They represent a small population of children with a disproportionate consumption of healthcare resources, the costliest of which is hospitalizations. Trends in hospitalizations of CMC at children’s hospitals are unclear. Objective: To examine trends of CMC hospitalizations at children’s hospitals. Design/Methods: We conducted a retrospective cohort study during the study period 2012-2021 of hospital discharges for children ages 0-18 in the Pediatric Health Information System, an administrative database of 45 US children’s hospitals. We excluded hospitals that did not consistently contribute data during all years of the study period. We also excluded the year 2020 (which had a disproportionate percentage of CMC discharges) and discharges for routine newborns and obstetrics/gynecology. We identified discharges of CMC using Feudtner’s CCC algorithm. Our main outcomes were trends in the percentage of discharges, hospital days, and hospital costs (estimated from charges) for CMC from 2012 to 2021. Trends were measured as compound annual growth rates (CAGR) of the percentage of discharges, days, and costs. We used generalized estimating equations to assess for statistical significance in trends, adjusting for hospital clustering. Results: Among the 45 included hospitals, there were 7,280,392 discharges. Forty percent (40.1%) of the discharges were for CMC. The percentage of discharges for CMC remained unchanged from 39.5% in 2012 to 39.9% in 2021 (CAGR: 0.09, p=0.83) (Figure). However, the percentage of hospital days increased significantly from 65.1% to 67.8% (CAGR: 0.40, p< .001) and the percentage of costs increased from 73.9% to 76.3% (CAGR: 0.31, p=0.01) (Figure). CMC with technology dependence (32.5%) and gastrointestinal CCCs (28.1%) had the highest percentage of hospital days in 2021. CMC with neonatal/premature (CAGR: 4.2) and renal/urologic (CAGR: 4.0) CCCs had the highest growth in hospital days from 2012 to 2021 (Table).
Conclusion(s): The percentage of discharges at children’s hospitals attributable to CMC has remained constant in the past decade. However, CMC are responsible for an increasing proportion of hospital days and costs, especially those CMC with neonatal/premature and renal/urologic CCCs. These findings have potential implications for the future delivery of inpatient pediatric care and related costs. Future research should test clinical interventions for safely reducing hospital days of CMC, thereby reducing health care costs in this population.
