Hospital Variation in Health Care Utilization by Children With Medical Complexity

Author:

Ralston Shawn L.12,Harrison Wade13,Wasserman Jared3,Goodman David C.123

Affiliation:

1. Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire;

2. Section of Pediatric Hospital Medicine, Children’s Hospital at Dartmouth, Lebanon, New Hampshire; and

3. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire

Abstract

BACKGROUND: Although children with medical complexity have high health care needs, little is known about the variation in care provided between centers. This information may be particularly useful in identifying opportunities to improve quality and reduce costs. METHODS: We conducted a retrospective population-based observational cohort study using all payer claims databases for children aged 30 days to <18 years residing in Maine, New Hampshire, and Vermont from 2007 to 2010. We identified hospital-affiliated cohorts (n = 6) of patients (n = 8216) with medical complexity by using diagnostic codes from both inpatient and outpatient claims. Children were assigned to the hospital where they received the most inpatient days, or their outpatient visits if no hospitalization occurred. Outcomes of interest included patient encounters, medical imaging, and diagnostic testing. Adjusted relative rates were calculated with overdispersed Poisson regression models. RESULTS: Adjusting for patient characteristics, the number of inpatient (relative rate 0.84 vs 2.28) and intensive care days (relative rate 0.45 vs 1.28) varied by more than twofold, whereas office (relative rate 0.77 vs 1.12) and emergency department visits (relative rate 0.71 vs 1.37) varied to a lesser extent. There was also marked variation in the use of imaging, and other diagnostic tests, with particularly high variation in electrocardiography (relative rate 0.35 vs 2.81) and head MRI (relative rate 0.72 vs 2.12). CONCLUSIONS: Depending on where they receive care, children with medical complexity experience widely different patterns of utilization. These findings indicate the need for identifying best practices for this growing patient population.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Reference23 articles.

1. Children with complex chronic conditions in inpatient hospital settings in the United States.;Simon;Pediatrics,2010

2. Children with medical complexity: an emerging population for clinical and research initiatives.;Cohen;Pediatrics,2011

3. Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980–1997.;Feudtner;Pediatrics,2000

4. A new definition of children with special health care needs.;McPherson;Pediatrics,1998

5. Increasing prevalence of medically complex children in US hospitals.;Burns;Pediatrics,2010

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