Children with chronic conditions increasingly use available resources in children's hospitals

(Press-News.org) CHICAGO – Children with chronic conditions increasingly used more resources in a group of children's hospitals compared with patients without a chronic condition, according to a report that analyzed data from 28 U.S. children's hospitals between 2004 and 2009, and is being published Online First by Archives of Pediatrics & Adolescent Medicine, a JAMA Network publication.

To compare inpatient resource use trends for healthy children and children with chronic health conditions of varying degrees of medical complexity, Jay G. Berry, M.D., M.P.H., with Children's Hospital Boston and Harvard Medical School, and colleagues, analyzed data from 1,526,051 unique patients hospitalized from January 2004 through December 2009, who were assigned to one of five chronic condition groups.

The authors found that between 2004 and 2009, hospitals experienced a greater increase in the number of children hospitalized with vs. without a chronic condition (19.2 percent vs. 13.7 percent) and the greatest cumulative increase (32.5 percent) was attributable to children with a significant chronic condition affecting two or more body systems. These children accounted for 19.2 percent (n=63,203) of patients, 27.2 percent (n=111,685) of hospital discharges, 48.9 percent (n=1.1 million) of hospital days, and 53.2 percent (n=$9.2 billion) of hospital charges in 2009.

"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," the authors conclude. (Arch Pediatr Adolesc Med. Published online December 24, 2012. doi:10.1001/jamapediatrics.2013.432. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: This study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development career development award, a grant from the National Center for Research Resources and Seattle Children's Hospital. One author also reported that he is a co-developer of CRGs and receives a consultation fee from the National Association of Children's Hospitals and Related Institutions for classification research. The Child Health Corporation for America received the CRGs for this analysis from 3M Health Information Systems on a no-cost license. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: What Can Be Learned by Residents Caring for Children with Lifelong, Chronic, Complex Conditions?

In an accompanying editorial, Julia A. McMillan, M.D., with Johns Hopkins School of Medicine, Baltimore, writes, "if the data provided by Berry et al can be assumed to be representative of other large pediatric hospitals, there are important implications for pediatric resident education."

"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," they conclude.

(Arch Pediatr Adolesc Med. Published online December 24, 2012. doi:10.1001/jamapediatrics.2013.406. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: No conflicts of interest were reported. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Implications of the Growing Use of Freestanding Children's Hospitals

In another accompanying editorial, Evan S. Fieldston, M.D., M.B.A., M.S., and Steven M. Altschuler, M.D., of The Children's Hospital of Philadelphia, write, "Freestanding children's hospitals play a unique role in caring for children, particularly those with special needs…Therefore, the implications for the future of pediatric health care and its reimbursement are profound"

"Challenges will continue to be present in how to match patient needs and preferences and how to properly align payment for them. Given limited resources, the obligation of pediatric health care providers to society is to do our best to promote the best outcomes at the right level of efficiency and cost," they conclude.

(Arch Pediatr Adolesc Med. Published online December 24, 2012. doi:10.1001/jamapediatrics.2013.126. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: No conflicts of interest were reported. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

### For more information, contact JAMA Network Media Relations at 312-464-JAMA (5262) or email mediarelations@jamanetwork.org.

Media Advisory: To contact Jay G. Berry, M.D., M.P.H., call Rob Graham or Erin Tornatore at 617-919-3110 or email Rob.Graham@childrens.harvard.edu or erin.tornatore@childrens.harvard.edu. To contact editorial author Julia A. McMillan, M.D., call Kim Hoppe at 410-502-9430 or email khoppe1@jhmi.edu. To contact editorial corresponding author Steven M. Altschuler, M.D., call Ashley Moore at 267-426-6050 or 267-426-6071.

An author podcast will be available on the journal website after the embargo lifts: http://archpedi.jamanetwork.com/