title: Hospital Utilization Among Children With the Highest Annual Inpatient Cost.
abstract: OBJECTIVE
  Children who experience high health care costs are increasingly enrolled in clinical initiatives to improve their health and contain costs. Hospitalization is a significant cost driver. We describe hospitalization trends for children with highest annual inpatient cost (CHIC) and identify characteristics associated with persistently high inpatient costs in subsequent years.
  
  
  METHODS
  Retrospective study of 265 869 children age 2 to 15 years with ≥1 admission in 2010 to 39 children's hospitals in the Pediatric Health Information System. CHIC were defined as the top 10% of total inpatient costs in 2010 (n = 26 574). Multivariate regression and regression tree modeling were used to distinguish individual characteristics and interactions of characteristics, respectively, associated with persistently high inpatient costs (≥80th percentile in 2011 and/or 2012).
  
  
  RESULTS
  The top 10% most expensive children (CHIC) constituted 56.9% ($2.4 billion) of total inpatient costs in 2010. Fifty-eight percent (n = 15 391) of CHIC had no inpatient costs in 2011 to 2012, and 27.0% (n = 7180) experienced persistently high inpatient cost. Respiratory chronic conditions (odds ratio [OR] = 3.0; 95% confidence interval [CI], 2.5-3.5), absence of surgery in 2010 (OR = 2.0; 95% CI, 1.8-2.1), and technological assistance (OR = 1.6; 95% CI, 1.5-1.7) were associated with persistently high inpatient cost. In regression tree modeling, the greatest likelihood of persistence (65.3%) was observed in CHIC with ≥3 hospitalizations in 2010 and a chronic respiratory condition.
  
  
  CONCLUSIONS
  Most children with high children's hospital inpatient costs in 1 year do not experience hospitalization in subsequent years. Interactions of hospital use and clinical characteristics may be helpful to determine which children will continue to experience high inpatient costs over time.
authors.affiliation: Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; and Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; and Robert Wood Johnson Foundation Clinical Scholars Program, Yale University, New Haven, Connecticut; alon.peltz@yale.edu.
authors.forename: Alon
authors.initials: A
authors.lastname: Peltz
authors.affiliation: Children's Hospital Association, Overland Park, Kansas;
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.affiliation: PolicyLab at The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
authors.forename: David M
authors.initials: DM
authors.lastname: Rubin
authors.affiliation: Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts; and Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts;
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Mandl
authors.affiliation: Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington;
authors.forename: John
authors.initials: J
authors.lastname: Neff
authors.affiliation: Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado;
authors.forename: Mark
authors.initials: M
authors.lastname: Brittan
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.affiliation: Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee;
authors.forename: David E
authors.initials: DE
authors.lastname: Hall
authors.affiliation: Department of Pediatrics; Center for Applied Research and Evaluation, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas; and.
authors.forename: Dennis Z
authors.initials: DZ
authors.lastname: Kuo
authors.affiliation: Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; and Divison of Hospital-Based Medicine, Lurie Children's Hospital of Chicago, Chicago, Illinois.
authors.forename: Rishi
authors.initials: R
authors.lastname: Agrawal
authors.affiliation: Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D006776:Hospitals, Pediatric / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012044:Regression Analysis; D012189:Retrospective Studies