Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
The Hospital for Sick Children, Toronto, Ontario, Canada.
JAMA Netw Open. 2022 Feb 1;5(2):e2147447. doi: 10.1001/jamanetworkopen.2021.47447.
Identifying conditions that could be prioritized for research based on health care system burden is important for developing a research agenda for the care of hospitalized children. However, existing prioritization studies are decades old or do not include data from both pediatric and general hospitals.
To assess the prevalence, cost, and variation in cost of pediatric hospitalizations at all general and pediatric hospitals in Ontario, Canada, with the aim of identifying conditions that could be prioritized for future research.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study used health administrative data from 165 general and pediatric hospitals in Ontario, Canada. Children younger than 18 years with an inpatient hospital encounter between April 1, 2014, and March 31, 2019, were included.
Condition-specific prevalence, cost of pediatric hospitalizations, and condition-specific variation in cost per inpatient encounter across hospitals. Variation in cost was evaluated using (1) intraclass correlation coefficient (ICC) and (2) number of outlier hospitals. Costs were adjusted for inflation to 2018 US dollars.
Overall, 627 314 inpatient hospital encounters (44.8% among children younger than 30 days and 53.0% among boys) at 165 hospitals (157 general and 8 pediatric) costing $3.3 billion were identified. A total of 408 003 hospitalizations (65.0%) and $1.4 billion (43.8%) in total costs occurred at general hospitals. Among the 50 most prevalent and 50 most costly conditions (of 68 total conditions), the top 10 highest-cost conditions accounted for 55.5% of all costs and 48.6% of all encounters. The conditions with highest prevalence and cost included low birth weight (86.2 per 1000 encounters; $676.3 million), preterm newborn (38.0 per 1000 encounters; $137.4 million), major depressive disorder (20.7 per 1000 encounters; $78.3 million), pneumonia (27.3 per 1000 encounters; $71.6 million), other perinatal conditions (68.0 per 1000 encounters; $65.8 million), bronchiolitis (25.4 per 1000 encounters; $54.6 million), and neonatal hyperbilirubinemia (47.9 per 1000 encounters; $46.7 million). The highest variation in cost per encounter among the most costly medical conditions was observed for 2 mental health conditions (other mental health disorders [ICC, 0.28] and anxiety disorders [ICC, 0.19]) and 3 newborn conditions (intrauterine hypoxia and birth asphyxia [ICC, 0.27], other perinatal conditions [ICC, 0.17], and surfactant deficiency disorder [ICC, 0.17]).
This population-based cross-sectional study of hospitalized children identified several newborn and mental health conditions as having the highest prevalence, cost, and variation in cost across hospitals. Findings of this study can be used to develop a research agenda for the care of hospitalized children that includes general hospitals and to ultimately build a more substantial evidence base and improve patient outcomes.
根据医疗保健系统负担来确定优先考虑的研究条件对于制定住院儿童护理的研究议程非常重要。然而，现有的优先排序研究已有几十年的历史，或者没有包括儿科和综合医院的数据。
评估加拿大安大略省所有综合医院和儿科医院的儿科住院率、成本和成本变化，旨在确定可优先考虑未来研究的条件。
设计、地点和参与者：这项基于人群的横断面研究使用了来自加拿大安大略省 165 家综合医院和儿科医院的健康管理数据。纳入了 2014 年 4 月 1 日至 2019 年 3 月 31 日期间在住院期间发生住院的 18 岁以下儿童。
特定疾病的患病率、儿科住院成本以及医院间每个住院患者的特定疾病成本变化。使用（1）组内相关系数（ICC）和（2）异常值医院数量来评估成本变化。对通货膨胀进行了调整，以将成本转换为 2018 年的美元。
总体而言，在 165 家医院（包括 157 家综合医院和 8 家儿科医院）共确定了 627314 例住院（30 天以下儿童的 44.8%和男孩的 53.0%），费用为 33 亿美元。共有 408003 例（65.0%）和 14 亿美元（43.8%）的住院费用发生在综合医院。在 68 种疾病中，50 种最常见和 50 种最昂贵的疾病中，前 10 种最昂贵的疾病占总成本的 55.5%，占总就诊量的 48.6%。患病率和成本最高的疾病包括低出生体重（86.2/1000 次就诊；676.3 百万美元）、早产新生儿（38.0/1000 次就诊；137.4 百万美元）、重度抑郁症（20.7/1000 次就诊；78.3 百万美元）、肺炎（27.3/1000 次就诊；71.6 百万美元）、其他围产期疾病（68.0/1000 次就诊；65.8 百万美元）、细支气管炎（25.4/1000 次就诊；54.6 百万美元）和新生儿高胆红素血症（47.9/1000 次就诊；46.7 百万美元）。在最昂贵的医疗条件中，每个患者的成本变化最大的是 2 种精神健康疾病（其他精神健康障碍[ICC，0.28]和焦虑障碍[ICC，0.19]）和 3 种新生儿疾病（宫内缺氧和出生窒息[ICC，0.27]），其他围产期疾病[ICC，0.17]，和表面活性剂缺乏症[ICC，0.17]）。
这项基于人群的横断面研究对住院儿童进行了研究，发现了一些新生儿和心理健康状况，这些状况在医院间具有最高的患病率、成本和成本变化。这项研究的结果可用于制定住院儿童护理的研究议程，其中包括综合医院，并最终建立更坚实的证据基础，改善患者的预后。
