Inpatient health care utilization for children dependent on long-term mechanical ventilation

Abstract

Objective: The objective was to describe the characteristics of pediatric discharges associated with long-term mechanical ventilation (LTMV) compared with those with complex chronic conditions (CCCs), and evaluate trends over time in health care utilization for the discharges associated with LTMV.

Methods: The Kids' Inpatient Database, compiled by the Agency for Healthcare Research and Quality, was used. Routine newborn care was excluded. Discharges associated with LTMV were identified by using the International Classification of Diseases, Ninth Revision, code v46.1x and compared with discharges associated with CCCs in 2006 using simple regression and χ(2) analyses. Trends in LTMV-associated discharges from 2000 to 2006 were assessed using variance-weighted least squares regression.

Results: In 2006, there were an estimated 7812 discharges associated with LTMV. Compared with discharges for children with CCCs, LTMV discharges had significantly higher mortality, longer lengths of stay, higher mean charges, more emergency department admissions, and more discharges to long-term care. From 2000 to 2006, there was a 55% increase in the number of LTMV discharges and a concurrent 70% increase in aggregate hospital charges. The majority of LTMV discharges occurred in children 4 years old and younger, and ∼50% of the aggregate charges were for children younger than 1 year.

Conclusions: Discharges for children associated with LTMV require substantively greater inpatient resource use than other children with CCCs. As the number of discharges and associated aggregate charges increase over time, additional research must examine patterns of care for specific clinical subgroups of LTMV, especially children aged 4 years and younger.

FIGURE 1

Mean charges according to age category from 2000 to 2006. ^a Charges corrected to 2009 US$ using the medical consumer price index. ^b Statistically significant change in mean charges over time, P < .05. Statistically significant differences in mean charges according to each age category, P < .001.

FIGURE 2

Rate of discharge disposition according to age category in 2006. ^a Rate expressed in number of discharges associated with LTMV per 100 000 nonroutine newborn pediatric discharges. ^b Statistically significant differences in disposition according to age category, P < .05.