Contributions of Children With Multiple Chronic Conditions to Pediatric Hospitalizations in the United States: A Retrospective Cohort Analysis.
Contributions of Children With Multiple Chronic Conditions to Pediatric Hospitalizations in the United States: A Retrospective Cohort Analysis.
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DOI：
10.1542/hpeds.2016-0179
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发表时间：
2017-07-01
影响因子：
--
通讯作者：
Hall, Matt
中科院分区：
文献类型：
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作者：
Berry, Jay G;Ash, Arlene S;Hall, Matt
背景：患有多种慢性病（CMCC）的儿童越来越多地使用医院护理。我们评估了 CMCC 使用了多少美国儿科住院护理，以及哪些慢性病是医院使用的主要驱动因素。方法：对儿童住院数据库中 2012 年所有 230 万美国急症护理出院儿童的 0 至 18 岁儿童进行回顾性分析。美国因怀孕、分娩、新生儿和新生儿护理而住院的 450 万人没有得到评估。我们采用了医疗保健研究和质量机构的慢性病指标，对没有慢性病、患有一种慢性病或患有多种慢性病的儿童住院进行分类，并确定哪些特定的 CMCC 慢性病与医院资源使用率较高相关。 结果：在所有儿科急症护理住院儿童中，34.3% 为无慢性病儿童，36.5% 为患有 1 种慢性病的儿童，29.3% 为 CMCC。在 236 亿美元的住院总费用中，分别有 19.7%、27.4% 和 53.9% 用于患有 0 种、1 种和多种疾病的儿童，住院天数的比例也相似。住院天数最多的三类人群如下：无慢性病的儿童（20.9%）、有精神健康问题且至少患有一种其他慢性病的儿童（20.2%）、有精神健康问题且无其他慢性病的儿童（13.3%）。最常见的心理健康状况是药物滥用障碍和抑郁症。结论：2012 年，CMCC 占急诊住院治疗的四分之一以上，占美国儿科护理医院总费用的二分之一。 CMCC 医院资源的大量使用涉及患有心理健康相关疾病的儿童。
BACKGROUND: Children with multiple chronic conditions (CMCC) are increasingly using hospital care. We assessed how much of US pediatric inpatient care is used by CMCC and which chronic conditions are the key drivers of hospital use.METHODS: A retrospective analysis of all 2.3 million US acute-care hospital discharges in 2012 for children age 0 to 18 years in the Kids' Inpatient Database. The 4.5 million US hospitalizations for pregnancy, childbirth, and newborn and neonatal care were not assessed. We adapted the Agency for Healthcare Research and Quality's Chronic Condition Indicators to classify hospitalizations for children with no, 1, or multiple chronic conditions, and to determine which specific chronic conditions of CMCC are associated with high hospital resource use.RESULTS: Of all pediatric acute-care hospitalizations, 34.3% were of children with no chronic conditions, 36.5% were of those with 1 condition, and 29.3% were of CMCC. Of the $23.6 billion in total hospital costs, 19.7%, 27.4%, and 53.9% were for children with 0, 1, and multiple conditions, respectively, and similar proportions were observed for hospital days. The three populations accounted for the most hospital days were as follows: children with no chronic condition (20.9%), children with a mental health condition and at least 1 additional chronic condition (20.2%), and children with a mental health condition without an additional chronic condition (13.3%). The most common mental health conditions were substance abuse disorders and depression.CONCLUSIONS: CMCC accounted for over one-fourth of acute-care hospitalizations and one-half of all hospital dollars for US pediatric care in 2012. Substantial CMCC hospital resource use involves children with mental health-related conditions.