title: Inpatient growth and resource use in 28 children's hospitals: a longitudinal, multi-institutional study.
abstract: OBJECTIVE
  To compare inpatient resource use trends for healthy children and children with chronic health conditions of varying degrees of medical complexity.
  
  
  METHODS
  Retrospective cohort analysis.
  
  
  METHODS
  Twenty-eight US children's hospitals.
  
  
  METHODS
  A total of 1 526 051 unique patients hospitalized from January 1, 2004, through December 31, 2009, who were assigned to 1 of 5 chronic condition groups using 3M's Clinical Risk Group software.
  
  
  METHODS
  None.
  
  
  METHODS
  Trends in the number of patients, hospitalizations, hospital days, and charges analyzed with linear regression.
  
  
  RESULTS
  Between 2004 and 2009, hospitals experienced a greater increase in the number of children hospitalized with vs without a chronic condition (19.2% vs 13.7% cumulative increase, P < .001). The greatest cumulative increase (32.5%) was attributable to children with a significant chronic condition affecting 2 or more body systems, who accounted for 19.2% (n = 63 203) of patients, 27.2% (n = 111 685) of hospital discharges, 48.9% (n = 1.1 million) of hospital days, and 53.2% ($9.2 billion) of hospital charges in 2009. These children had a higher percentage of Medicaid use (56.5% vs 49.7%; P < .001) compared with children without a chronic condition. Cerebral palsy (9179 [14.6%]) and asthma (13 708 [21.8%]) were the most common primary diagnosis and comorbidity, respectively, observed among these patients.
  
  
  CONCLUSIONS
  Patients with a chronic condition increasingly used more resources in a group of children's hospitals than patients without a chronic condition. The greatest growth was observed in hospitalized children with chronic conditions affecting 2 or more body systems. Children's hospitals must ensure that their inpatient care systems and payment structures are equipped to meet the protean needs of this important population of children.
authors.affiliation: Division of General Pediatrics, Children's Hospital Boston, Boston, MA, USA. jay.berry@childrens.harvard.edu
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.forename: David E
authors.initials: DE
authors.lastname: Hall
authors.forename: Dennis Z
authors.initials: DZ
authors.lastname: Kuo
authors.forename: Eyal
authors.initials: E
authors.lastname: Cohen
authors.forename: Rishi
authors.initials: R
authors.lastname: Agrawal
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Mandl
authors.forename: Holly
authors.initials: H
authors.lastname: Clifton
authors.forename: John
authors.initials: J
authors.lastname: Neff
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000191:economics / Q000628:therapy*; D015331:Cohort Studies; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D017722:Hospital Charges / Q000706:statistics & numerical data / Q000639:trends; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D006776:Hospitals, Pediatric / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008137:Longitudinal Studies; D008484:Medicaid / Q000706:statistics & numerical data / Q000639:trends; D015233:Models, Statistical; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult