Patterns and Costs of Health Care Use of Children With Medical Complexity

Cohen, Eyal; Berry, Jay G.; Camacho, Ximena; Anderson, Geoff; Wodchis, Walter P.; Guttmann, Astrid

doi:10.1542/peds.2012-0175

Cited by 513 publications

(535 citation statements)

References 36 publications

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“…[1][2][3][4][5][6] In recent years, there has been a significant rise in innovative clinical programs targeting this population of children. 7 Health plans, children's hospitals, and other entities are enrolling high-cost children into care management programs to improve their health.…”

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confidence: 99%

“…[9][10][11][12][13] As for their adult counterparts, 14 hospital care is a significant contributor to the overall cost accrued by children with chronic conditions. 2,5,6 Many children who experience high health care costs incur frequent hospital admissions and lengthy hospitalizations. [15][16][17][18] Previous studies have reported that hospital care accounts for as much as 80% of total health care spending in children with severe chronic conditions.…”

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confidence: 99%

“…[15][16][17][18] Previous studies have reported that hospital care accounts for as much as 80% of total health care spending in children with severe chronic conditions. 2,5,6 Spending on other health services, such as emergency department care, medications, and primary care, is much smaller. 19 Hospital costs and how the costs are distributed (eg, to ICU or surgical care) vary significantly by the chronic conditions experienced by the children.…”

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confidence: 99%

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Hospital Utilization Among Children With the Highest Annual Inpatient Cost

et al. 2016

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BACKGROUND AND OBJECTIVES: Children who experience high health care costs are increasingly enrolled in clinical initiatives to improve their health and contain costs. Hospitalization is a significant cost driver. We describe hospitalization trends for children with highest annual inpatient cost (CHIC) and identify characteristics associated with persistently high inpatient costs in subsequent years.

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Hospital Utilization Among Children With the Highest Annual Inpatient Cost

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“…Although estimates indicate they account for <1% of the pediatric population, children with medical complexity and technology dependence use almost one-third of all pediatric health care expenditures and make multiple transitions across providers and health care settings. 1,3,6,7 For instance, in 2006, children with medical complexity accounted for 10% of all US pediatric acute care hospital admissions, www.hospitalpediatrics.org 26% of pediatric hospital days, 40% of pediatric hospital charges, up to 92% of technology assistance procedures, and 435 inpatient deaths. 7 It has become imperative for health care providers to study and understand the needs of this population as models of care are developed.…”

Section: Discussionmentioning

confidence: 99%

Unplanned Readmissions to Acute Care From a Pediatric Postacute Care Hospital: Incidence, Clinical Reasons, and Predictive Factors

O’Brien

Dumas

Nash

et al. 2015

Hospital Pediatrics

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KEY WORDS POTENTIAL CONFLICT OF INTEREST:The authors have indicated they have no potential confl icts of interest to disclose. abstract OBJECTIVE: To identify the incidence, clinical reasons, and predictive factors for unplanned readmissions to acute care from a pediatric postacute care hospital. METHODS:A retrospective cohort analysis of all discharges between October 1, 2011, and September 30, 2013 (n = 298), in 1 pediatric postacute care hospital was conducted. Descriptive statistics were used to summarize the incidence and assess the clinical reasons for all readmissions to an acute care hospital. Logistic regression was used to identify predictive factors of any unplanned readmission to an acute care hospital. RESULTS:Thirty percent of all postacute care hospital discharges were unplanned readmissions to an acute care hospital. The primary clinical reasons for unplanned readmissions to acute care were respiratory decompensation (54%) and infection (20%). Requiring invasive mechanical ventilation, being <1 year of age, and having a postacute care length of stay <30 days were the 3 predictive factors.CONCLUSIONS: This is the fi rst study to examine readmission to acute care from a postacute care hospital and to identify age, length of stay, and dependence on mechanical ventilation as predictive factors. Understanding which children are likely to require an unplanned readmission may allow providers to develop strategies to minimize this occurrence.

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“…Any conditions listed in the past medical history on either document were referenced to a previously published diagnostic list, which outlines complex-chronic diseases. 16 Conditions not listed on the list were then considered NCCs.…”

Section: Complexity and Chronicity Of Preexisting Conditionsmentioning

confidence: 99%

The Influence of Patient Characteristics on the Perceived Value of Inpatient Educational Experiences by Medical Trainees

Farrell

Mahant

Wadhwa

et al. 2015

Hospital Pediatrics

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where trainees are educated through their clinical experience. Few studies have explored trainees' perceptions of the educational value of these patient care experiences. The aim of this study was to identify pediatric patient characteristics that medical trainees perceive as educationally valuable. METHODS:Over 2 months, trainees on pediatric inpatient wards ranked the perceived educational value of patients under their care on a 4-point bipolar Likert scale. Three patient characteristics were examined: complex-chronic and noncomplex-chronic preexisting conditions, difficult social circumstances, and rare diseases. Patient-level predictors of cases perceived as educationally valuable (defined as scores $3) were examined by using univariate and multivariate analyses. RESULTS:A total of 325 patients were rated by 51 trainees (clinical medical students [45%], first-year residents [29%], third-year residents/fellows [26%]). Rare diseases had a higher educational value score (adjusted odds ratio 1.76, 95% confidence interval 1.08-2.88, P 5 .02). Complex-chronic and noncomplex-chronic preexisting conditions and difficult social circumstances did not affect the perceived educational value. CONCLUSIONS:Trainees attribute the most educational value to caring for patients with rare diseases. Although trainees' perceptions of learning do not necessarily reflect actual learning, they may influence personal interest and limit learning from an educational experience. Knowledge of trainee perceptions of educational experience therefore can direct medical educators' approaches to inpatient education. Because of the critical role it has to play, there has been a call to expand research on workplace learning in residents to include an exploration of organizational practices, experiences, and learning attitudes.2 In addition to these contributors to the intended and explicit curriculum of workplace learning, one must also consider the important contribution of the so-called "informal and hidden curriculum."The hidden curriculum is defined as the unscripted and highly interpersonal forms of teaching between faculty and students (the informal curriculum) and/or a set of influences at the level of organizational structure and culture (the hidden curriculum).3 One manifestation of the informal and hidden curriculum is the potential for the development and/or consolidation of biases and attitudes related to specific patient types.3-5 It has been well documented that physicians experience bias toward specific patient social and demographic traits, with ethnicity being the most well documented.6,7 Studies of bias toward patients with chronic disease, 8 physical disabilities, 9 and children with cerebral palsy 10 have suggested that these biases develop in the early stages of training as medical students express less optimistic views of outcomes for these patients. Physicians may develop cynicism and frustrations because of an inability to "cure" patients with chronic conditions and disabilities who often have many comorbidities, communi...

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Patterns and Costs of Health Care Use of Children With Medical Complexity

Cited by 513 publications

References 36 publications

Hospital Utilization Among Children With the Highest Annual Inpatient Cost

Hospital Utilization Among Children With the Highest Annual Inpatient Cost

Unplanned Readmissions to Acute Care From a Pediatric Postacute Care Hospital: Incidence, Clinical Reasons, and Predictive Factors

The Influence of Patient Characteristics on the Perceived Value of Inpatient Educational Experiences by Medical Trainees

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