title: Patterns and costs of health care use of children with medical complexity.
abstract: OBJECTIVE
  Health care use of children with medical complexity (CMC), such as those with neurologic impairment or other complex chronic conditions (CCCs) and those with technology assistance (TA), is not well understood. The objective of the study was to evaluate health care utilization and costs in a population-based sample of CMC in Ontario, Canada.
  
  
  METHODS
  Hospital discharge data from 2005 through 2007 identified CMC. Complete health system use and costs were analyzed over the subsequent 2-year period.
  
  
  RESULTS
  The study identified 15 771 hospitalized CMC (0.67% of children in Ontario); 10 340 (65.6%) had single-organ CCC, 1063 (6.7%) multiorgan CCC, 4368 (27.6%) neurologic impairment, and 1863 (11.8%) had TA. CMC saw a median of 13 outpatient physicians and 6 distinct subspecialists. Thirty-six percent received home care services. Thirty-day readmission varied from 12.6% (single CCC without TA) to 23.7% (multiple CCC with TA). CMC accounted for almost one-third of child health spending. Rehospitalization accounted for the largest proportion of subsequent costs (27.2%), followed by home care (11.3%) and physician services (6.0%). Home care costs were a much larger proportion of costs in children with TA. Children with multiple CCC with TA had costs 3.5 times higher than children with a single CCC without TA.
  
  
  CONCLUSIONS
  Although a small proportion of the population, CMC account for a substantial proportion of health care costs. CMC make multiple transitions across providers and care settings and CMC with TA have higher costs and home care use. Initiatives to improve their health outcomes and decrease costs need to focus on the entire continuum of care.
authors.affiliation: Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Eyal
authors.initials: E
authors.lastname: Cohen
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
authors.forename: Ximena
authors.initials: X
authors.lastname: Camacho
authors.forename: Geoff
authors.initials: G
authors.lastname: Anderson
authors.forename: Walter
authors.initials: W
authors.lastname: Wodchis
authors.forename: Astrid
authors.initials: A
authors.lastname: Guttmann
mesh_terms: D000293:Adolescent; D019090:Case Management / Q000191:economics / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000191:economics* / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D015897:Comorbidity; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D009422:Nervous System Diseases / Q000191:economics / Q000453:epidemiology / Q000401:mortality; D009864:Ontario; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000191:economics* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012656:Self-Help Devices / Q000191:economics / Q000706:statistics & numerical data; D014600:Utilization Review / Q000191:economics / Q000706:statistics & numerical data