Variation in Specialty Care Hospitalization for Children With Chronic Conditions in California

Chamberlain, Lisa; Chan, Jia; Mahlow, Pamela; Huffman, Lynne C.; Chan, Kristen; Wise, Paul H.

doi:10.1542/peds.2009-1109

Cited by 23 publications

(19 citation statements)

References 27 publications

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“…Patients in tertiary care hospitals are generally sicker than those in general hospitals and have higher risks of adverse outcomes and decreased quality of life due to complex chronic illnesses. 32,33 Our fi ndings are consistent with other studies showing that complex chronically ill children at freestanding children's hospitals have a relatively high burden of mental health comorbidities. 4 As hospitals develop budgets and place greater emphasis on revenue-generating ser vices, the effect of PCLS on pediatric inpatient care should not be under estimated.…”

Section: Discussionsupporting

confidence: 90%

Effect of Timing of Psychiatry Consultation on Length of Pediatric Hospitalization and Hospital Charges

Bujoreanu

White

Gerber

et al. 2015

Hospital Pediatrics

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Objectives: The purpose of this study was to evaluate the impact of timing of a psychiatry consultation during pediatric hospitalization on length of hospital stay and total hospitalization charges. Methods: The charts of 279 pediatric patients (totaling 308 consultations) referred to the psychiatry consultation liaison service at a freestanding tertiary pediatric hospital between January 1, 2010, and June 30, 2010 were retrospectively analyzed. The variables analyzed included the following: patient demographic characteristics; dates of admission, psychiatric consultation, and discharge; psychiatric diagnoses based on the psychiatric diagnostic evaluation; psychiatric treatment disposition; and illness severity and total charges associated with the medical stay. Results: Earlier psychiatry consultation was associated with shorter length of stay and lower hospitalization charges after adjusting for psychiatric functioning, physical illness severity, and psychiatric disposition. Poorer psychiatric functioning and milder physical illness were associated with shorter referral time. Conclusions: Timely involvement of psychiatry consultation services during a medical or surgical hospitalization was associated with reductions in length of stay and total hospital charges in pediatric settings. These findings have important effects on quality of care via decreasing burden on the patient and family and on the medical system resources. Educating pediatric health care providers about the importance of early psychiatry consultation regardless of physical illness severity or psychiatric acuity will likely improve resource management for patients and hospitals.

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Section: Discussionsupporting

confidence: 90%

Effect of Timing of Psychiatry Consultation on Length of Pediatric Hospitalization and Hospital Charges

Bujoreanu

White

Gerber

et al. 2015

Hospital Pediatrics

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“…Thus, we likely underestimated the frequency of PICU readmission (35). However, many patients with CCC tend to receive their on-going care in their respective regional, tertiary center (36). Second, some of the study patients’ index admission were likely readmissions of previous admissions that we did not have data on.…”

Section: Discussionmentioning

confidence: 99%

Repeated Critical Illness and Unplanned Readmissions Within 1 Year to PICUs*

Edwards

Lucas

Boscardin

et al. 2017

Critical Care Medicine

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Objectives To determine the incidence of unplanned readmissions to pediatric intensive care units (PICUs) within one year and examine risk factors associated with repeated readmission. Design, Settings, & Patients Retrospective cohort study of 93,379 patients discharged between 2009 and 2010 from 76 North American PICUs. Measurements Outcomes of index admissions and unplanned readmissions were compared. Timing of readmissions and variation of proportion of readmissions across sites were examined. Cumulative incidence curves for readmission were constructed. Time-to-event analyses were performed to examine factors associated with readmission within one year and to estimate their hazard ratios (HR). Main Results Eleven percent (10,233) of patients had 15,625 unplanned readmissions within one year to the same PICU; 3.4% had two or more readmissions. Readmissions had significantly higher PICU mortality and longer PICU length of stay, compared to index admissions (4.0% versus 2.5%, and 2.5 versus 1.6 days, all P<0.001). Median time to readmission was 30 days for all readmissions; 3.5 days for readmissions during the same hospitalization; and 66 days for different hospitalizations. Time-to-event analyses showed that having more complex chronic conditions (CCCs) was associated with earlier readmission—adjusted HR 2.9 for one CCC; HR 4.8 for two CCC; HR 9.6 for three or more CCC, all P<0.001 compared no CCC). Most specific CCC conferred a greater risk of readmission, and some had considerably higher risk than others. Conclusions Unplanned readmissions occurred in a sizable minority of PICU patients. Patients with CCCs and particular conditions were at much higher risk for readmission.

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“…12 Patients are generally sicker than those in general hospitals and have higher risks of adverse outcomes and decreased quality of life due to complex chronic illnesses. 13,14 Little is known about the differences between the 2 types of pediatric hospitals in the mental health diagnoses they care for, which may differ given the differences in their medical diagnoses. To measure and improve the quality of inpatient pediatric mental health care, it is important to understand the national landscape of all hospitals admitting children as well as to explore how the patient population in tertiary care centers might differ from the national group.…”

Section: (Continued On Last Page)mentioning

confidence: 99%

Common and Costly Hospitalizations for Pediatric Mental Health Disorders

et al. 2014

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BACKGROUND AND OBJECTIVES: Inpatient pediatric mental health is a priority topic for national quality measurement and improvement, but nationally representative data on the patients admitted or their diagnoses are lacking. Our objectives were: to describe pediatric mental health hospitalizations at general medical facilities admitting children nationally; to assess which pediatric mental health diagnoses are frequent and costly at these hospitals; and to examine whether the most frequent diagnoses are similar to those at free-standing children’s hospitals. METHODS: We examined all discharges in 2009 for patients aged 3 to 20 years in the nationally representative Kids’ Inpatient Database (KID) and in the Pediatric Health Information System (free-standing children’s hospitals). Main outcomes were frequency of International Classification of Diseases, Ninth Revision, Clinical Modification–defined mental health diagnostic groupings (primary and nonprimary diagnosis) and, using KID, resource utilization (defined by diagnostic grouping aggregate annual charges). RESULTS: Nearly 10% of pediatric hospitalizations nationally were for a primary mental health diagnosis, compared with 3% of hospitalizations at free-standing children’s hospitals. Predictors of hospitalizations for a primary mental health problem were older age, male gender, white race, and insurance type. Nationally, the most frequent and costly primary mental health diagnoses were depression (44.1% of all mental health admissions; $1.33 billion), bipolar disorder (18.1%; $702 million), and psychosis (12.1%; $540 million). CONCLUSIONS: We identified the child mental health inpatient diagnoses with the highest frequency and highest costs as depression, bipolar disorder, and psychosis, with substance abuse an important comorbid diagnosis. These diagnoses can be used as priority conditions for pediatric mental health inpatient quality measurement.

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Variation in Specialty Care Hospitalization for Children With Chronic Conditions in California

Abstract: Significant variation exists in specialty care hospitalization among chronically ill children in California. These findings suggest a need for greater scrutiny of clinical practices and child health policies that shape patterns of hospitalization of children with serious chronic disease.

Cited by 23 publications

References 27 publications

Effect of Timing of Psychiatry Consultation on Length of Pediatric Hospitalization and Hospital Charges

Effect of Timing of Psychiatry Consultation on Length of Pediatric Hospitalization and Hospital Charges

Repeated Critical Illness and Unplanned Readmissions Within 1 Year to PICUs*

Common and Costly Hospitalizations for Pediatric Mental Health Disorders

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