Inpatient growth and resource use in 28 children's hospitals: a longitudinal, multi-institutional study.
Inpatient growth and resource use in 28 children's hospitals: a longitudinal, multi-institutional study.
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DOI：
10.1001/jamapediatrics.2013.432
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发表时间：
2013-02
期刊：
影响因子：
26.1
通讯作者：
Neff, John
中科院分区：
文献类型：
--
作者：
Berry, Jay G.;Hall, Matt;Hall, David E.;Kuo, Dennis Z.;Cohen, Eyal;Agrawal, Rishi;Mandl, Kenneth D.;Clifton, Holly;Neff, John
比较健康儿童和患有不同程度医学复杂性的慢性健康状况的儿童的住院资源使用趋势。回顾性队列分析。美国28家儿童医院从2004年1月1日至2009年12月31日，共有1526051名独特的住院患者，使用3 M的临床风险组软件将他们分配到5个慢性疾病组中的1个。一个也没有。使用线性回归分析患者数量、住院、住院天数和费用的趋势。2004年至2009年期间，医院经历了更大的增长，住院的儿童与非慢性疾病（19.2%对13.7%的累积增长，P <0.001）。最大的累积增长（32.5%）归因于患有影响两个或两个以上身体系统的严重慢性疾病的儿童，占19.2%。（n=63 203）例患者，27.2%（n=111 685）、48.9%（n= 110万）的住院日数及53.2%（92亿元）的住院收费。与没有慢性病的儿童相比，这些儿童使用医疗补助的比例更高（56.5%对49.7%; P<0.001）。脑瘫（9179例[14.6%]）和哮喘（13708例[21.8%]）分别是这些患者中最常见的初步诊断和合并症。在一组儿童医院中，慢性病患者比非慢性病患者使用更多的资源。在患有影响2个或更多身体系统的慢性疾病的住院儿童中观察到最大的增长。儿童医院必须确保其住院护理系统和支付结构能够满足这一重要儿童群体的多变需求。
To compare inpatient resource use trends for healthy children and children with chronic health conditions of varying degrees of medical complexity. Retrospective cohort analysis. Twenty-eight US children’s hospitals. 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. None. Trends in the number of patients, hospitalizations, hospital days, and charges analyzed with linear regression. 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. 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.
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