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.

Figure 1

Patient and resource use growth trends of patients with and without chronic conditions in 28 children’s hospitals. This figure presents the cumulative percent growth of the number of individual patients, hospitalizations, bed days, and charges in reference to 2004. The P value indicates the difference in the slope of the trend for the 2 groups of patients, adjusted for confounders in a generalized estimation equation.

Figure 2

Patient and resource use growth trends of patients in the chronic condition cohort groupings in 28 children’s hospitals. This figure presents the cumulative percent growth of the number of individual patients, hospitalizations, bed days, and charges in reference to 2004. The P value indicates the difference in the slope of the trend for children with chronic conditions in 2 or more body systems compared with children who did not have a chronic condition, adjusted for confounders in a generalized estimation equation.

Figure 3

Inpatient health services use by chronic condition cohort groupings in 28 children’s hospitals. This figure presents the percent of hospital use attributable to each group of patients in 2009.