Children with chronic conditions used more hospital resources

Children’s hospitals have become the forefront of pediatric specialty care, but researchers have found that pediatric patients with chronic conditions increasingly used more hospital resources compared with patients without a chronic condition. “Population growth, rising disease prevalence, and improved patient survival do not fully explain these trends,” Jay G. Berry, MD, MPH, and colleagues wrote.

Berry, of the division of pediatrics at Children’s Hospital Boston and Harvard Medical School, and colleagues conducted a retrospective cohort analysis of 1,526,051 patients at 28 US children’s hospitals to assess inpatient resource use trends among healthy children and children with chronic health conditions.

According to data, the increase in the number of children hospitalized was highest among patients with a chronic disease vs. without a chronic condition (19.2% vs. 13.7%; P<.001) between 2004 and 2009. The highest increase — 32.5% — was due to patients with a significant chronic condition that affected two or more body systems. This 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.

Further data indicate that cerebral palsy (14.6%) and asthma (21.8%) were the most commonly diagnosed chronic conditions in this patient population.

In one accompanying editorial, Julia A. McMillan, MD, of the department of pediatrics at The Johns Hopkins School of Medicine, wrote that communication between consultants and subspecialists, social workers, case managers, home health agencies, pharmacies and families is an important aspect of caring for hospitalized patients.

“The challenge for residency program directors is to ensure that the lessons learned caring for complex patients with lifelong chronic illness in the inpatient setting are not forgotten when residents see those patients during subspecialty clinic assignments or during their continuity clinic,” McMillan wrote.

These lessons have the potential to reduce the frequency or duration of hospital stays for this patient population, she added.

In a second editorial, Evan S. Fieldston, MD, MBA, MS, of The Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, and Steven M. Altschuler, MD, also of The Children’s Hospital of Philadelphia, wrote that matching patients’ needs and limited resources will continue to present challenges.

“For all activities, opportunities to reduce cost, set appropriate prices, and improve value will make the system more productive and increase available resources for all those who need it,” they wrote.

Nonetheless, Berry and colleagues said children’s hospitals should be equipped to meet the versatile needs of pediatric patients.

For more information:

Berry JG. Arch Pediatr Adolesc Med. 2012;doi:10.1001/jamapediatrics.2013.432.

Fieldston ES. Arch Pediatr Adolesc Med. 2012;doi:10.1001/2013.jamapediatrics.126.

McMillan JA. Arch Pediatr Adolesc Med. 2012;doi:10.1001/2013.jamapediatrics.406.

Disclosure: John Neff, MD, one of the study researchers, reports being a co-developer of CRGs and receiving a consultation fee from the National Association of Children’s Hospitals and Related Institutions for classification research. The Child Health Corporation of America received the CRGs for this analysis from 3M Health Information Systems on a no-cost license. Altschuler, Fieldston and McMillan report no relevant financial disclosures.