Impact of COVID-19 on Admissions and Outcomes for Children With Complex Chronic Conditions

Abstract

BACKGROUND: Although pediatric health care use declined during the coronavirus disease 2019 (COVID-19) pandemic, the impact on children with complex chronic conditions (CCCs) has not been well reported. OBJECTIVE: To describe the impact of the pandemic on inpatient use and outcomes for children with CCCs. METHODS: This multicenter cross-sectional study used data from the Pediatric Health Information System. We examined trends in admissions between January 2020 through March 2021, comparing them to the same timeframe in the previous 3 years (pre-COVID-19). We used generalized linear mixed models to examine the association of the COVID-19 period and outcomes for children with CCCs presenting between March 16, 2020 to March 15, 2021 (COVID-19 period) to the same timeframe in the previous 3 years (pre-COVID-19). RESULTS: Children with CCCs experienced a 19.5% overall decline in admissions during the COVID-19 pandemic. Declines began in the second week of March of 2020, reaching a nadir in early April 2020. Changes in admissions varied over time and by admission indication. Children with CCCs hospitalized for pneumonia and bronchiolitis experienced overall declines in admissions of 49.7% to 57.7%, whereas children with CCCs hospitalized for diabetes experienced overall increases in admissions of 21.2%. Total and index length of stay, costs, and ICU use, although statistically higher during the COVID-19 period, were similar overall to the pre-COVID-19 period. CONCLUSIONS: Total admissions for children with CCCs declined nearly 20% during the pandemic. Among prevalent conditions, the greatest declines were observed for children with CCCs hospitalized with respiratory illnesses. Despite declines in admissions, overall hospital-level outcomes remained similar.

Impact of the COVID‐19 pandemic on hospitalizations of children with neurologic impairment

“…The decrease in hospitalizations for children with NI in this early‐COVID era may not be unexpected considering previous studies demonstrating dramatic decreases in hospitalizations in this period, and changes in the epidemiology of hospitalizations, particularly decreases in respiratory‐related hospitalizations. 5 , 6 , 7 , 8 , 9 , 10 Interestingly, the ~14% decrease in hospitalizations for children with NI is less than the ~20% decrease in hospitalizations for the broader population of CMC in a study by Markham et al 10 However, the magnitude of the decrease in infectious respiratory infections is nearly identical in both populations. 10 The lesser decrease in hospitalizations for children with NI likely reflects the unavoidable nature of many hospitalizations for these children, given the complexity of their underlying comorbidities.…”

“… 5 , 6 , 7 , 8 , 9 , 10 Interestingly, the ~14% decrease in hospitalizations for children with NI is less than the ~20% decrease in hospitalizations for the broader population of CMC in a study by Markham et al 10 However, the magnitude of the decrease in infectious respiratory infections is nearly identical in both populations. 10 The lesser decrease in hospitalizations for children with NI likely reflects the unavoidable nature of many hospitalizations for these children, given the complexity of their underlying comorbidities.…”

“…1,4 The COVID-19 pandemic was associated with overall lower pediatric hospitalization rates in 2020 including for children with medical complexity (CMC). [5][6][7][8][9][10] Many CMC have chronic conditions (e.g., cystic fibrosis, congenital heart disease, end-stage renal disease) with well-defined subspecialty care programs, evidence-based therapies, and standardized care. In contrast, the heterogeneous conditions that encompass the subpopulation of CMC with NI exist in a complex and fragmented care system requiring the coordination of multiple subspecialists with undefined disease outcomes and a limited evidence base to direct treatment or standardize care.…”

“…The COVID‐19 pandemic was associated with overall lower pediatric hospitalization rates in 2020 including for children with medical complexity (CMC) 5–10 . Many CMC have chronic conditions (e.g., cystic fibrosis, congenital heart disease, end‐stage renal disease) with well‐defined subspecialty care programs, evidence‐based therapies, and standardized care.…”

COVID-19 Pandemic Impact on Pediatricians Entering the Pediatric Workforce

“…1 , 2 , 3 , 4 In both inpatient and outpatient settings, clinical volumes dropped dramatically during the pandemic, resulting in fewer in-person patient encounters, a change in the range of diagnoses seen, and, at some programs, redeployment to care for adults. 3 , 5 , 6 , 7 Hospital financial constraints due to decreased patient volume, 8 , 9 potential attrition of physicians retiring early, 10 and the pediatric subspecialty deficit may have impacted potential positions available during the pandemic, and, in turn, may have impacted career and employment decisions of pediatricians entering the workforce. The impact of the COVID-19 pandemic on employment opportunities and decisions among graduating pediatric residents has not been well described.…”