Adults With Chronic Health Conditions Originating in Childhood: Inpatient Experience in Children's Hospitals

Abstract

WHAT'S KNOWN ON THIS SUBJECT:Health care innovations have improved survival in children with conditions previously fatal in childhood. Implications for specific diseases have been reported, but little information is available on disease comparisons or population increases in adult survivors of childhood illness. WHAT THIS STUDY ADDS:In this study of adults with chronic childhood diseases treated at 30 children's hospitals over a 10-year period, 6 conditions were compared and patient population growth was projected. The disparity between diagnoses suggests the existence of systemic barriers to the transition of these patients to adult health care providers. abstract OBJECTIVE: To describe the rate of increase of the population of adults seeking care as inpatients in children's hospitals over time. PATIENTS AND METHODS:We analyzed data from January 1, 1999, to December 31, 2008, from patients hospitalized at 30 academic children's hospitals, including growth rates according to age group (pediatric: aged Ͻ18 years; transitional: aged 18 -21 years; or adult: aged Ͼ21 years) and disease. RESULTS:There were 3 343 194 hospital discharges for 2 143 696 patients. Transitional patients represented 2.0%, and adults represented 0.8%, totaling 59 974 patients older than 18 years. The number of unique patients, admissions, patient-days, and charges increased in all age groups over the study period and are projected to continue to increase. Resource use was disproportionately higher in the older ages. The growth of transitional patients exceeded that of others, with 6.9% average annual increase in discharges, 7.6% in patient-days, and 15% in charges. Chronic conditions occurred in 87% of adults compared with 48% of pediatric patients. Compared with pediatric patients, the rates of increase of inpatient-days increased significantly for transitional age patients with cystic fibrosis, malignant neoplasms, and epilepsy, and for adults with cerebral palsy. Annual growth rates of charges increased for transitional and adult patients for all diagnoses except cystic fibrosis and sickle cell disease. CONCLUSIONS:The population of adults with diseases originating in childhood who are hospitalized at children's hospitals is increasing, with varying disease-specific changes over time. Our findings underscore the need for proactive identification of strategies to care for adult survivors of pediatric diseases. Pediatrics 2011;128:5-13

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