McDaniel Corrie E, Richardson Troy, Gay James C, Berry Jay G, Hall Matt
Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.
Children's Hospital Association, Lenexa, Kansas.
Pediatrics. 2025 Feb 1;155(2). doi: 10.1542/peds.2024-067859.
Traditional classification of children's and nonchildren's hospitals is based on physical structure and branding. We grouped hospitals with the most similar types of pediatric patients.
Retrospective analysis of 2.8 million hospitalizations in 3993 hospitals for patients 0 to 20 years in the 2019 Kids' Inpatient Database. After stratifying low-volume hospitals (greater than 100 annual admissions), we grouped the remaining hospitals using K-means clustering by case-mix of neonatal services and pediatric diagnosis diversity (DD).
Clustering distinguished 6 hospital groups. Group 1 (n = 1665 [1.6% of hospitalizations]) represented low pediatric volume hospitals (13 annual pediatric hospitalizations [IQR 3-82]). Group 2 (n = 118 hospitals [1.1% of hospitalizations]) provided no neonatal care, had low DD (12 [IQR 4-34]), and had a median age of 17 years. Group 3 (n = 1156 [19.7% of hospitalizations]) hospitals provided low-severity neonatal care with low DD (13 [IQR 7-19). Group 4 (n = 674 hospitals, [24.0% of hospitalizations]) provided moderate-severity neonatal care (2.2 [ IQR 2.1-2.4]) and increased DD (24 [ IQR 6-34]). Group 5 (n = 238 hospitals [20.5% of hospitalizations]) had a similar severity of neonatal care as group 4 (2.3 [IQR 2.1-2.5]), but 2.7 times greater DD (64 [IQR 55-77]). Group 6 (n = 142 hospitals [33.0% of hospitalizations]) had the highest-severity neonatal care (2.6 [IQR 2.3-3.1]) and the greatest DD (127 [113-140]).
Children receive inpatient care across 6 groups of hospitals, distinguished by neonatal case-mix and DD. Future studies should investigate the utility of these groups for peer comparisons with health care use and outcomes.
儿童医院和非儿童医院的传统分类基于物理结构和品牌。我们将儿科患者类型最相似的医院归为一组。
对2019年儿童住院数据库中3993家医院里年龄在0至20岁的280万例住院病例进行回顾性分析。在对年收治量较少的医院（年收治量超过100例）进行分层后，我们使用K均值聚类法，根据新生儿服务的病例组合和儿科诊断多样性（DD），将其余医院进行分组。
聚类区分出6个医院组。第1组（n = 1665例[占住院病例的1.6%]）代表儿科收治量低的医院（年儿科住院病例13例[四分位间距3 - 82例]）。第2组（n = 118家医院[占住院病例的1.1%]）不提供新生儿护理，DD低（12例[四分位间距4 - 34例]），中位年龄为17岁。第3组（n = 1156例[占住院病例的19.7%]）的医院提供低严重程度的新生儿护理，DD低（13例[四分位间距7 - 19例]）。第4组（n = 674家医院，[占住院病例的24.0%]）提供中度严重程度的新生儿护理（2.2例[四分位间距2.1 - 2.4例]），且DD增加（24例[四分位间距6 - 34例]）。第5组（n = 238家医院[占住院病例的20.5%]）的新生儿护理严重程度与第4组相似（2.3例[四分位间距2.1 - 2.5例]），但DD是第4组的2.7倍（64例[四分位间距55 - 77例]）。第6组（n = 142家医院[占住院病例的33.0%]）的新生儿护理严重程度最高（2.6例[四分位间距2.3 - 3.1例]），DD最大（127例[113 - 140例]）。
儿童在6组医院接受住院治疗，这些医院组通过新生儿病例组合和DD进行区分。未来的研究应调查这些组在与医疗保健使用和结果进行同行比较方面的效用。
