Contributions of Children With Multiple Chronic Conditions to Pediatric Hospitalizations in the United States: A Retrospective Cohort Analysis

Berry, Jay G.; Ash, Arlene S.; Cohen, Eyal; Hasan, Fareesa; Feudtner, Chris; Hall, Matt

doi:10.1542/hpeds.2016-0179

Cited by 81 publications

(56 citation statements)

References 29 publications

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“…In 2012, there were ∼2 million hospitalizations of children ,18 years old, and two-thirds of these children had $1 chronic conditions. 9,10 Therefore, the hospital represents a promising setting for reaching a large number of children at high risk, particularly because missed opportunities for influenza vaccination occur commonly before hospitalization. 11,12 Nonetheless, the authors of 2 recent studies found that approximately half of parents declined the influenza vaccine for their vaccine-eligible child during hospitalization.…”

mentioning

confidence: 99%

Parental Vaccine Hesitancy and Declination of Influenza Vaccination Among Hospitalized Children

Hofstetter

Simon

Lepere³

et al. 2018

Hospital Pediatrics

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Parents frequently decline the influenza vaccine for their child during hospitalization. In this study, we aimed to assess the role of vaccine hesitancy in these declinations. METHODS: This cross-sectional survey study was conducted among English-speaking parents of influenza vaccineeligible children who were hospitalized between October 2014 and April 2015. Between July 2015 and September 2015, parents were recruited via mail to complete the validated Parent Attitudes about Childhood Vaccines (PACV) survey (modified for influenza vaccination). PACV scores (0-100 scale) were dichotomized into scores of $50 (hesitant) and ,50 (nonhesitant). The primary outcome was parental declination of the influenza vaccine for their child during hospitalization. A secondary outcome was the declination reason documented during hospitalization. The main independent variable was parental vaccine hesitancy status, determined by the PACV score. Multivariable logistic regression was used to examine the association between vaccine hesitancy and influenza vaccine declination, adjusting for sociodemographic, visit, and clinical characteristics. The relationship between vaccine hesitancy and declination reason was also explored. RESULTS: Of 199 parents (18% response rate), 24% were vaccine hesitant and 53% declined the influenza vaccine for their child during hospitalization. Vaccine hesitancy (versus nonhesitancy) was associated with declining influenza vaccination (adjusted odds ratio: 6.4; 95% confidence interval: 2.5-16.5). The declination reason differed by vaccine hesitancy status, with a higher proportion of parents who were hesitant versus nonhesitant reporting "vaccine concern" or "vaccine unnecessary." CONCLUSIONS: Vaccine hesitancy was prevalent in this limited sample of parents of hospitalized children and associated with influenza vaccine declination. Additional investigation in a large, diverse, prospectively recruited cohort is warranted given the potential sampling bias present in this study.

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confidence: 99%

Parental Vaccine Hesitancy and Declination of Influenza Vaccination Among Hospitalized Children

Hofstetter

Simon

Lepere³

et al. 2018

Hospital Pediatrics

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“…Chronic conditions were assessed over the first 2 years of observation. ICD‐9‐CM diagnosis codes from all outpatient office visits and inpatient encounters were collected and categorized using the pediatric modification of the Agency for Healthcare Research and Quality Clinical Classification Software (CCS) and Chronic Condition Indicator (CCI) algorithms . Together, these tools generated a systematic classification of distinct chronic clinical conditions .…”

Section: Methodsmentioning

confidence: 99%

Impact of multimorbidity subgroups on the health care use of early pediatric cancer survivors

Harrington

Qato

Antoon

et al. 2019

Cancer

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BACKGROUND: Although pediatric cancer survivors in the United States are at an increased risk of developing chronic conditions, to the authors' knowledge there is limited information regarding the types and combinations of conditions they experience in the years immediately after the completion of cancer therapy. METHODS: An observational cohort study of early pediatric cancer survivors (children who were ≥2 years from the end of therapy and aged ≤18 years) was conducted using the Truven Health MarketScan (r) Commercial Claims and Encounters database (2009)(2010)(2011)(2012)(2013)(2014). Latent class analysis was used to identify comorbidity groups among the subset with ≥2 conditions. Group-level health care use was compared with survivors without chronic conditions using multivariate regression. RESULTS: A total of 3687 early survivors were identified, of whom approximately 41.2% had no chronic conditions, 22.5% had 1 chronic condition, and 36.3% had ≥2 chronic conditions. Among those with ≥2 chronic conditions, 5 groups emerged: 1) general pediatric morbidity (35.4%); 2) central nervous system (CNS) (22.4%); 3) mental health conditions (22.2%); 4) endocrine (26.2%); and 5) CNS with endocrine (3.8%). The CNS group experienced the highest expenditures, at $17,964 more per year (95% CI, $1446-$34,482) compared with survivors without chronic conditions. The CNS group also had the highest odds of an emergency department visit (adjusted odds ratio, 1.71; 95% CI, 1.15-2.56). The endocrine group had the highest odds of hospitalization (odds ratio, 2.29; 95% CI, 1. 24-4.22). CONCLUSIONS: Multimorbidity is common among pediatric cancer survivors. The current study identified 5 distinct comorbidity subgroups, all of which experienced high, yet differential, rates of health care use. The results of the current study highlight the complex health care needs of early survivors and provide evidence for the design of targeted survivorship services and interventions. Cancer 2020;126:649-658.

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“…To identify the presence and number of chronic conditions, we used the AHRQ Chronic Condition Indicator system, which categorizes over 14,000 ICD-9-CM diagnosis codes into chronic vs non-chronic conditions. 14,15 Children hospitalized with a chronic condition were further classified as having a complex chronic condition (CCC) using Feudtner and colleagues' ICD-9-CM diagnosis classification scheme. 16 CCCs represent defined diagnosis groupings expected to last longer than 12 months and involving either a single organ system, severe enough to require specialty pediatric care and hospitalization, or multiple organ systems.…”

Section: Demographic and Clinical Characteristicsmentioning

confidence: 99%

Use of Post‐Acute Facility Care in Children Hospitalized With Acute Respiratory Illness

Berry

Wilson

Dumas

et al. 2017

Journal of Hospital Medicine

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Contributions of Children With Multiple Chronic Conditions to Pediatric Hospitalizations in the United States: A Retrospective Cohort Analysis

Abstract: CMCC accounted for over one-fourth of acute-care hospitalizations and one-half of all hospital dollars for US pediatric care in 2012. Substantial CMCC hospital resource use involves children with mental health-related conditions.

Cited by 81 publications

References 29 publications

Parental Vaccine Hesitancy and Declination of Influenza Vaccination Among Hospitalized Children

Parental Vaccine Hesitancy and Declination of Influenza Vaccination Among Hospitalized Children

Impact of multimorbidity subgroups on the health care use of early pediatric cancer survivors

Use of Post‐Acute Facility Care in Children Hospitalized With Acute Respiratory Illness

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