Department of Pediatrics, Baylor College of Medicine, Houston, Texas;
Children's Hospital Association, Lenexa, Kansas.
Hosp Pediatr. 2020 Mar;10(3):206-213. doi: 10.1542/hpeds.2019-0258. Epub 2020 Feb 5.
High-cost hospitalizations (HCHs) account for a substantial proportion of pediatric health care expenditures. We aimed to (1) describe the distribution of pediatric HCHs across hospital types caring for children and (2) compare characteristics of pediatric HCHs by hospital type.
Cross-sectional analysis of all pediatric hospitalizations in the 2012 Kids' Inpatient Database. HCHs were defined as costs >$40 000 (94th percentile). Hospitals were categorized as children's, small general, and large general.
Approximately 166 000 HCHs were responsible for 50.8% of aggregate hospital costs ($18.1 of $35.7 billion) and were mostly at children's hospitals (65%). Children with an HCH were largely neonates (45%), had public insurance (50%), and had ≥1 chronic condition (74%). A total of 131 children's hospitals cared for a median of 559 HCHs per hospital (interquartile range [IQR]: 355-1153) compared to 76 HCHs per hospital (IQR: 32-151) at 397 large general hospitals and 5 HCHs per hospital (IQR: 2-22) at 3581 small general hospitals. The median annual aggregate cost for HCHs was $60 million (IQR: $36-$135) per children's hospital compared to $6.6 million (IQR: $2-$15) per large general hospital and $300 000 (IQR: $116 000-$1.5 million) per small general hospital. HCHs from children's hospitals encompassed nearly 5 times as many unique clinical conditions as large general hospitals and >30 times as many as small general hospitals.
Children's hospitals cared for a disproportionate volume, cost, and diversity of HCHs compared to general hospitals. Future studies should characterize the factors driving cost, resources, and reimbursement practices for HCH to ensure the long-term financial viability of the pediatric health care system.
高成本住院（HCH）占儿科医疗支出的很大一部分。我们旨在：（1）描述儿童医院类型对儿科 HCH 的分布情况；（2）按医院类型比较儿科 HCH 的特征。
对 2012 年儿科住院数据库中所有儿科住院患者进行的横断面分析。HCH 定义为费用> $ 40000（第 94 百分位）。医院分为儿童医院、小综合医院和大综合医院。
大约 166000 例 HCH 占总住院费用的 50.8%（$181 亿美元中的 35.7 亿美元），主要发生在儿童医院（65%）。HCH 患儿主要为新生儿（45%），有公共保险（50%），≥1 种慢性病（74%）。共有 131 家儿童医院每家医院平均收治 559 例 HCH（中位数[IQR]：355-1153），而 397 家大型综合医院每家医院收治 76 例 HCH（IQR：32-151），3581 家小型综合医院每家医院收治 5 例 HCH（IQR：2-22）。HCH 每年的总费用中位数为每家儿童医院 6000 万美元（IQR：3600 万至 1.35 亿美元），每家大型综合医院 660 万美元（IQR：200 万至 1500 万美元），每家小型综合医院 30 万美元（IQR：11.6 万至 150 万美元）。儿童医院的 HCH 涉及近 5 倍于大型综合医院的独特临床情况，>30 倍于小型综合医院。
与综合医院相比，儿童医院收治的 HCH 数量、成本和种类都不成比例。未来的研究应该描述推动 HCH 成本、资源和报销实践的因素，以确保儿科医疗保健系统的长期财务可行性。
