Short Heather L, Sarda Samir, Travers Curtis, Hockenberry Jason, McCarthy Ian, Raval Mehul V
Children's Healthcare of Atlanta, Atlanta, Georgia;
Division of Pediatric Surgery, Departments of Surgery and.
Hosp Pediatr. 2018 Dec;8(12):753-760. doi: 10.1542/hpeds.2017-0152. Epub 2018 Nov 8.
The evolving role of children's hospitals (CHs) in the setting of rising health care costs has not been fully explored. We compared pediatric inpatient discharge volumes and costs by hospital type and examined the impact of care complexity and hospital-level factors on costs.
A retrospective, cross-sectional study of care between 2000 and 2009 was performed by using the Kids' Inpatient Database. Weighted discharge data were used to generate national estimates for a comparison of inpatient volume, cost, and complexity at CHs and nonchildren's hospitals (NCHs). Linear regression was used to assess how complexity, payer mix, and hospital-level characteristics affected inflation-adjusted costs.
Between 2000 and 2009, the number of discharges per 1000 children increased from 6.3 to 7.7 at CHs and dropped from 55.4 to 53.3 at NCHs. The proportion of discharges at CHs grew by 6.8% between 2006 and 2009 alone. In 2009, CHs were responsible for 12.6% (95% confidence interval: 10.4%-14.9%) of pediatric discharges and 14.7% of major therapeutic procedures, yet they accounted for 23.0% of inpatient costs. Costs per discharge were significantly higher at CHs than at NCHs for all years ( < .001); however, the increase in costs seen over time was not significant. Care complexity increased during the study period at both CHs and NCH, but it could not be used to fully account for the difference in costs.
National trends reveal a small rise in both the proportion of inpatient discharges and the hospital costs at CHs, with costs being significantly higher at CHs than at NCHs. Research into factors influencing costs and the role of CHs is needed to inform policy and contain costs.
儿童医院（CHs）在医疗保健成本不断上升的背景下所发挥的不断演变的作用尚未得到充分探讨。我们按医院类型比较了儿科住院患者出院量和成本，并研究了护理复杂性和医院层面因素对成本的影响。
利用儿童住院数据库对2000年至2009年期间的护理情况进行了一项回顾性横断面研究。加权出院数据用于生成全国估计数，以比较儿童医院和非儿童医院（NCHs）的住院量、成本和复杂性。采用线性回归来评估复杂性、支付方组合和医院层面特征如何影响经通胀调整后的成本。
2000年至2009年期间，儿童医院每1000名儿童的出院人数从6.3增加到7.7，而非儿童医院则从55.4降至53.3。仅在2006年至2009年期间，儿童医院的出院比例就增长了6.8%。2009年，儿童医院占儿科出院人数的12.6%（95%置信区间：10.4%-14.9%）和主要治疗程序的14.7%，但它们占住院成本的23.0%。所有年份中，儿童医院的每次出院成本均显著高于非儿童医院（P<0.001）；然而，随着时间推移成本的增加并不显著。在研究期间，儿童医院和非儿童医院的护理复杂性均有所增加，但这并不能完全解释成本差异。
全国趋势显示，儿童医院的住院出院比例和医院成本均略有上升，儿童医院的成本显著高于非儿童医院。需要对影响成本的因素和儿童医院的作用进行研究，以为政策提供信息并控制成本。
