Ananth Prasanna, Melvin Patrice, Feudtner Chris, Wolfe Joanne, Berry Jay G
Department of Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center,
Center for Patient Safety and Quality Research, Boston Children's Hospital, Boston, Massachusetts;
Pediatrics. 2015 Nov;136(5):938-46. doi: 10.1542/peds.2015-0260. Epub 2015 Oct 5.
Although many adults experience resource-intensive and costly health care in the last year of life, less is known about these health care experiences in children with life-threatening complex chronic conditions (LT-CCCs). We assessed hospital resource use in children by type and number of LT-CCCs.
A retrospective analysis of 1252 children with LT-CCCs, ages 1 to 18 years, who died in 2012 within 40 US children's hospitals of the Pediatric Health Information System database. LT-CCCs were identified with International Classification of Diseases, 9th Revision, Clinical Modification codes. Using generalized linear models, we assessed hospital admissions, days, costs, and interventions (mechanical ventilation and surgeries) in the last year of life by type and number of LT-CCCs.
In the last year of life, children with LT-CCCs experienced a median of 2 admissions (interquartile range [IQR] 1-5), 27 hospital days (IQR 7-84), and $142 562 (IQR $45 270-$410 087) in hospital costs. During the terminal admission, 76% (n = 946) were mechanically ventilated; 36% (n = 453) underwent surgery. Hospital use was greatest (P < .001) among children with hematologic/immunologic conditions (99 hospital days [IQR 51-146]; cost = $504 145 [IQR $250 147-$879 331]) and children with ≥3 LT-CCCs (75 hospital days [IQR 28-132]; cost = $341 222 [IQR $146 698-$686 585]).
Hospital use for children with LT-CCCs in the last year of life varies significantly across the type and number of conditions. Children with hematologic/immunologic or multiple conditions have the greatest hospital use. This information may be useful for clinicians striving to improve care for children with LT-CCCs nearing the end of life.
尽管许多成年人在生命的最后一年经历了资源密集型且成本高昂的医疗保健，但对于患有危及生命的复杂慢性病（LT - CCC）的儿童的这些医疗保健经历了解较少。我们按LT - CCC的类型和数量评估了儿童的医院资源使用情况。
对2012年在美国儿科健康信息系统数据库的40家儿童医院内死亡的1252名年龄在1至18岁的患有LT - CCC的儿童进行回顾性分析。使用国际疾病分类第九版临床修订本代码识别LT - CCC。我们通过LT - CCC的类型和数量，使用广义线性模型评估了生命最后一年的住院次数、住院天数、费用以及干预措施（机械通气和手术）。
在生命的最后一年，患有LT - CCC的儿童住院次数中位数为2次（四分位间距[IQR]为1 - 5），住院天数为27天（IQR为7 - 84），住院费用为142,562美元（IQR为45,270美元 - 410,087美元）。在临终住院期间，76%（n = 946）接受了机械通气；36%（n = 453）接受了手术。血液学/免疫学疾病患儿（99个住院日[IQR为51 - 146]；费用 = 504,145美元[IQR为250,147美元 - 879,331美元]）和患有≥3种LT - CCC的患儿（75个住院日[IQR为28 - 132]；费用 = 341,222美元[IQR为146,698美元 - 686,585美元]）的医院资源使用最多（P < 0.001）。
患有LT - CCC的儿童在生命最后一年的医院资源使用因疾病类型和数量的不同而有显著差异。血液学/免疫学疾病患儿或患有多种疾病的患儿医院资源使用最多。这些信息可能有助于临床医生努力改善对接近生命末期的患有LT - CCC的儿童的护理。
