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American Academy of Pediatrics
Research Articles

Care of Pediatric High-Cost Hospitalizations Across Hospital Types

Michelle A. Lopez, Matt Hall, Katherine A. Auger, Jessica L. Bettenhausen, Jeffrey D. Colvin, Gretchen J. Cutler, Evan Fieldston, Michelle L. Macy, Rustin Morse, Jean L. Raphael, Heidi Russell, Samir S. Shah and Marion R. Sills
Hospital Pediatrics March 2020, 10 (3) 206-213; DOI: https://doi.org/10.1542/hpeds.2019-0258
Michelle A. Lopez
aDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas;
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Matt Hall
bChildren’s Hospital Association, Lenexa, Kansas;
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Katherine A. Auger
cDepartment of Pediatrics, University of Cincinnati and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
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Jessica L. Bettenhausen
dChildren’s Mercy Hospital, Kansas City, Missouri;
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Jeffrey D. Colvin
dChildren’s Mercy Hospital, Kansas City, Missouri;
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Gretchen J. Cutler
eChildren’s Minnesota, Minneapolis, Minnesota;
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Evan Fieldston
fDepartment of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
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Michelle L. Macy
gDepartment of Pediatrics, University of Michigan, Ann Arbor, Michigan;
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Rustin Morse
hChildren’s Health System of Texas, Dallas, Texas; and
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Jean L. Raphael
aDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas;
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Heidi Russell
aDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas;
iCenter for Medical Ethics and Health Policy and
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Samir S. Shah
cDepartment of Pediatrics, University of Cincinnati and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
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Marion R. Sills
jDepartment of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado
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Abstract

BACKGROUND: High-cost hospitalizations (HCHs) account for a substantial proportion of pediatric health care expenditures. We aimed to (1) describe the distribution of pediatric HCHs across hospital types caring for children and (2) compare characteristics of pediatric HCHs by hospital type.

METHODS: Cross-sectional analysis of all pediatric hospitalizations in the 2012 Kids’ Inpatient Database. HCHs were defined as costs >$40 000 (94th percentile). Hospitals were categorized as children’s, small general, and large general.

RESULTS: Approximately 166 000 HCHs were responsible for 50.8% of aggregate hospital costs ($18.1 of $35.7 billion) and were mostly at children’s hospitals (65%). Children with an HCH were largely neonates (45%), had public insurance (50%), and had ≥1 chronic condition (74%). A total of 131 children’s hospitals cared for a median of 559 HCHs per hospital (interquartile range [IQR]: 355–1153) compared to 76 HCHs per hospital (IQR: 32–151) at 397 large general hospitals and 5 HCHs per hospital (IQR: 2–22) at 3581 small general hospitals. The median annual aggregate cost for HCHs was $60 million (IQR: $36–$135) per children’s hospital compared to $6.6 million (IQR: $2–$15) per large general hospital and $300 000 (IQR: $116 000–$1.5 million) per small general hospital. HCHs from children’s hospitals encompassed nearly 5 times as many unique clinical conditions as large general hospitals and >30 times as many as small general hospitals.

CONCLUSIONS: Children’s hospitals cared for a disproportionate volume, cost, and diversity of HCHs compared to general hospitals. Future studies should characterize the factors driving cost, resources, and reimbursement practices for HCH to ensure the long-term financial viability of the pediatric health care system.

  • Copyright © 2020 by the American Academy of Pediatrics
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Hospital Pediatrics: 10 (3)
Hospital Pediatrics
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1 Mar 2020
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Care of Pediatric High-Cost Hospitalizations Across Hospital Types
Michelle A. Lopez, Matt Hall, Katherine A. Auger, Jessica L. Bettenhausen, Jeffrey D. Colvin, Gretchen J. Cutler, Evan Fieldston, Michelle L. Macy, Rustin Morse, Jean L. Raphael, Heidi Russell, Samir S. Shah, Marion R. Sills
Hospital Pediatrics Mar 2020, 10 (3) 206-213; DOI: 10.1542/hpeds.2019-0258

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Care of Pediatric High-Cost Hospitalizations Across Hospital Types
Michelle A. Lopez, Matt Hall, Katherine A. Auger, Jessica L. Bettenhausen, Jeffrey D. Colvin, Gretchen J. Cutler, Evan Fieldston, Michelle L. Macy, Rustin Morse, Jean L. Raphael, Heidi Russell, Samir S. Shah, Marion R. Sills
Hospital Pediatrics Mar 2020, 10 (3) 206-213; DOI: 10.1542/hpeds.2019-0258
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