title: Long length of hospital stay in children with medical complexity.
abstract: Hospitalizations of children with medical complexity (CMC) account for one-half of hospital days in children, with lengths of stays (LOS) that are typically longer than those for children without medical complexity. The objective was to assess the impact of, risk factors for, and variation across children's hospitals regarding long LOS (≥10 days) hospitalizations in CMC.
  
  
  
  A retrospective study of 954,018 CMC hospitalizations, excluding admissions for neonatal and cancer care, during 2013 to 2014 in 44 children's hospitals. CMC were identified using 3M's Clinical Risk Group categories 6, 7, and 9, representing children with multiple and/or catastrophic chronic conditions. Multivariable regression was used to identify demographic and clinical characteristics associated with LOS ≥10 days. Hospital-level risk-adjusted rates of long LOS generated from these models were compared using a covariance test of the hospitals' random effect.
  
  
  
  Among CMC, LOS ≥10 days accounted for 14.9% (n = 142,082) of all admissions and 61.8% ($13.7 billion) of hospital costs. The characteristics most strongly associated with LOS ≥10 days were use of intensive care unit (ICU) (odds ratio [OR]: 3.5, 95% confidence interval [CI]: 3.4-3.5), respiratory complex chronic condition (OR: 2.7, 95% CI: 2.6-2.7), and transfer from another medical facility (OR: 2.1, 95% CI: 2.0-2.1). After adjusting for severity, there was significant (P < 0.001) variation in the prevalence of LOS ≥10 days for CMC across children's hospitals (range, 10.3%-21.8%).
  
  
  
  Long hospitalizations for CMC are costly. Their prevalence varies significantly by type of chronic condition and across children's hospitals. Efforts to reduce hospital costs in CMC might benefit from a focus on prolonged LOS. Journal of Hospital Medicine 2016;11:750-756. © 2016 Society of Hospital Medicine.
authors.affiliation: Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital and Columbia University Medical Center, New York, New York. jgold2@stanford.edu.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Gold
authors.affiliation: Department of Pediatrics, Children's Hospital Association, Overland Park, Kansas.|Department of Pediatrics, Children's Mercy Hospitals and Clinics and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Joanna
authors.initials: J
authors.lastname: Thomson
authors.affiliation: Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York.
authors.forename: Anupama
authors.initials: A
authors.lastname: Subramony
authors.affiliation: Department of Pediatrics, Division of Pediatric Medicine, Department of Pediatrics and Institute for Health Policy, Management and Evaluation, University of Toronto, and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Mahant
authors.affiliation: Department of Pediatrics, Children's Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Vineeta
authors.initials: V
authors.lastname: Mittal
authors.affiliation: Department of Pediatrics, Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Wilson
authors.affiliation: Department of Pediatrics, Children's Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Rustin
authors.initials: R
authors.lastname: Morse
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Grant M
authors.initials: GM
authors.lastname: Mussman
authors.affiliation: Department of Pediatrics, New York-Presbyterian Morgan Stanley Children's Hospital and Columbia University Medical Center, New York, New York.
authors.forename: Patricia
authors.initials: P
authors.lastname: Hametz
authors.affiliation: Department of Pediatrics, Children's Mercy Hospitals and Clinics and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
authors.forename: Amanda
authors.initials: A
authors.lastname: Montalbano
authors.affiliation: Department of Pediatrics, Children's National Medical Center and George Washington School of Medicine, Washington, DC.
authors.forename: Kavita
authors.initials: K
authors.lastname: Parikh
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Stacey
authors.initials: S
authors.lastname: Ishman
authors.affiliation: Department of Pediatrics, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Margaret
authors.initials: M
authors.lastname: O'Neill
authors.affiliation: Department of Pediatrics, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D016208:Databases, Factual; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics*; D006776:Hospitals, Pediatric / Q000191:economics; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index