Resource Utilization and Expenditures for Overweight and Obese Children

Hampl, Sarah; Carroll, Cathryn A.; Simon, Stephen D.; Sharma, Vidya

doi:10.1001/archpedi.161.1.11

Cited by 124 publications

(98 citation statements)

References 9 publications

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“…The median number of albuterol treatments in the inpatient setting was 14 (IQR, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. When albuterol treatments given in the ED were included, the median number of treatments increased to 38 (IQR, .…”

Section: Los and Resource Utilizationmentioning

confidence: 99%

“…[1][2][3] Recent studies have demonstrated worsened pediatric in-hospital outcomes, including mortality and increased resource utilization, for children with obesity across a range of diagnoses. [4][5][6][7][8][9][10] Although the mechanisms driving the association between obesity and in-hospital outcomes are not fully known, for asthma it is believed that adipocytes expressing inflammatory markers create a low level of systemic inflammation, thereby increasing the severity of allergic-type illnesses and decreasing the response to anti-inflammatory medications, such as steroids. [11][12][13][14][15][16][17][18] The relationship of obesity and in-hospital asthma outcomes is of particular interest because status asthmaticus is the most common reason for admission in children aged 3 to 12 years, accounting for approximately 150,000 admissions (7.4% of all hospitalizations for children and adolescents) and $835 million in hospital costs annually.…”

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confidence: 99%

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Childhood obesity and in-hospital asthma resource utilization

et al. 2014

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OBJECTIVE: To examine the relationship between pediatric obesity and inpatient length of stay (LOS), resource utilization, readmission rates, and total billed charges for inhospital status asthmaticus. DESIGN/METHODS:We conducted a cross-sectional study of patients 5 to 17 years old hospitalized with status asthmaticus to 1 free-standing children's hospital system over 12 months. Only hospitalized patients initially treated in the hospital's emergency department were included to ensure all therapies/charges were examined. Patients with complex chronic conditions, pneumonia, or lacking recorded body mass index (BMI) were excluded. The primary exposure was BMI percentile for age. The primary outcome was LOS (in hours). Secondary outcomes were 90-day readmission rate, billed charges, and resource utilization: number of albuterol treatments, chest radiographs, intravenous fluids, intravenous or intramuscular steroids, and intensive care unit admission. Bivariate, adjusted Poisson and logistic regression model analyses were performed. RESULTS:Five hundred eighteen patients met inclusion criteria. Most had a normal BMI (59.7%); 36.7% were overweight or obese. LOS, readmissions, and resource utilization outcomes were not associated with BMI category on bivariate analyses. After adjustment for demographic/ clinical characteristics, LOS decreased by 2% for each decile increase in BMI percentile for age. BMI percentile for age was not associated with billed charges, readmissions, or other measures of resource utilization.CONCLUSIONS: Although BMI decile for age is inversely associated with LOS for in-hospital pediatric status asthmaticus, the effect likely is not clinically meaningful. Pediatric hospitalizations for obesity-related conditions have doubled in the last decade, mirroring the trend of higher levels of childhood obesity in the United States. [1][2][3] Recent studies have demonstrated worsened pediatric in-hospital outcomes, including mortality and increased resource utilization, for children with obesity across a range of diagnoses. [4][5][6][7][8][9][10] Although the mechanisms driving the association between obesity and in-hospital outcomes are not fully known, for asthma it is believed that adipocytes expressing inflammatory markers create a low level of systemic inflammation, thereby increasing the severity of allergic-type illnesses and decreasing the response to anti-inflammatory medications, such as steroids. [11][12][13][14][15][16][17][18] The relationship of obesity and in-hospital asthma outcomes is of particular interest because status asthmaticus is the most common reason for admission in children aged 3 to 12 years, accounting for approximately 150,000 admissions (7.4% of all hospitalizations for children and adolescents) and $835 million in hospital costs annually. 19 Few prior studies have examined the association of obesity and asthma outcomes in the in-hospital setting. The studies examining this association have found patients with obesity to have a longer hospital length of stay (LOS) and i...

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Section: Los and Resource Utilizationmentioning

confidence: 99%

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confidence: 99%

Childhood obesity and in-hospital asthma resource utilization

et al. 2014

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“…One of the emerging and costly consequences of this epidemic is the increase in health care utilization by obese children for a number of conditions [2][3][4]. Documenting these disparities in health care use can help to better target prevention efforts and resource allocation.…”

Section: Introductionmentioning

confidence: 99%

“…However, a significant shortcoming of these databases for their use in obesity research is the lack of data on body weight. Previous studies have often linked utilization data with anthropometric data from surveillance systems, hospital charts, or surveys to identify overweight and obese children [2][3][4][5]. Such linkage may not always be feasible and other investigators have used an ICD-9/10 diagnosis of obesity from the administrative database to identify obese children [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Trends in Intervention Study for Childhood Obesity in Korea

Park¹,

Ma²,

Lee³

et al. 2017

Child Health Nurs Res

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Background: Administrative health databases are a valuable research tool to assess health care utilization at the population level. However, their use in obesity research limited due to the lack of data on body weight. A potential workaround is to use the ICD code of obesity to identify obese individuals. The objective of the current study was to investigate the sensitivity and specificity of an ICD code-based diagnosis of obesity from administrative health data relative to the gold standard measured BMI. Methods: Linkage of a population-based survey with anthropometric measures in elementary school children in 2003 with longitudinal administrative health data (physician visits and hospital discharges 1992-2006) from the Canadian province of Nova Scotia. Measured obesity was defined based on the CDC cut-offs applied to the measured BMI. An ICD code-based diagnosis obesity was defined as one or more ICD-9 (278) or ICD-10 code (E66-E68) of obesity from a physician visit or a hospital stay. Sensitivity and specificity were calculated and health care cost estimates based on measured obesity and ICD-based obesity were compared. Results: The sensitivity of an ICD code-based obesity diagnosis was 7.4% using ICD codes between 2002 and 2004. Those correctly identified had a higher BMI and had higher health care utilization and costs. Conclusions: An ICD diagnosis of obesity in Canadian administrative health data grossly underestimates the true prevalence of childhood obesity and overestimates the health care cost differential between obese and non-obese children.

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“…In addition, these children might require special diets and physical activity options as a part of their medical treatment; therefore, it is important that obese patients be identified on admission so that appropriate equipment and resources can be used and the patients' diagnoses of obesity can be addressed. In addition, because patients who have been diagnosed with obesity have greater resource use, 2 there is a financial need to identify these patients early in an effort to contain costs, a medical need to help them with their weight to decrease their risk for comorbid conditions, and a safety need to assess risk and identify appropriate equipment. We sought to determine if pediatric hospitals are routinely identifying patients with obesity as a diagnosis and, if so, if physicians and hospitals are addressing pediatric obesity.…”

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confidence: 99%

Identification and Treatment of Obesity as a Standard of Care for All Patients in Children's Hospitals

et al. 2011

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Obese children and adolescents have unique needs for specialized medical equipment while hospitalized and might require special diets and physical activity options as part of their medical treatment. It is important that patients with a diagnosis of obesity be identified on admission so that appropriate equipment and resources can be provided. We examined what components a healthy hospital environment should include and sought to determine if children's hospitals provide a healthy hospital environment that offers these components. In addition, we sought to determine if children's hospitals have policies in place to identify children with obesity so that appropriate resources and services can be offered to treat that diagnosis. We surveyed National Association of Children's Hospitals and Related Institutions member hospitals via a Web-based questionnaire and found that the majority of them do not have policies in place to identify patients with obesity. We did find that the majority of hospitals reported innovative programs or services to provide a healthy hospital environment for their patients, visitors, and staff but acknowledged limitations in providing some services. Specifically, children's hospitals can and should improve on their identification and management of obese pediatric patients.

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Resource Utilization and Expenditures for Overweight and Obese Children

Abstract: Increased health care utilization and charges reported in obese adults are also present in obese children. Most children with obesity had not been diagnosed as having obesity in this administrative data set.

Cited by 124 publications

References 9 publications

Childhood obesity and in-hospital asthma resource utilization

Childhood obesity and in-hospital asthma resource utilization

Trends in Intervention Study for Childhood Obesity in Korea

Identification and Treatment of Obesity as a Standard of Care for All Patients in Children's Hospitals

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