Hospital Utilization Among Children With the Highest Annual Inpatient Cost

Peltz, Alon; Hall, Matt; Rubin, David M.; Mandl, Kenneth D.; Neff, John M.; Brittan, Mark; Cohen, Eyal; Hall, David; Kuo, Dennis Z.; Agrawal, Rishi; Berry, Jay G.

doi:10.1542/peds.2015-1829

Cited by 47 publications

(39 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study expands upon the existing literature by employing a longitudinal, prospective design, and advanced analytic techniques. Consistent our findings, two publications using Medicaid data from the United States suggested that pediatric health care costs are mainly concentrated in a small group (5%‐10%) of children with distinctively high resource use, particularly those with a chronic respiratory condition . Another publication showed that a diagnosis of childhood asthma has been associated with being in the highest total cost quintile .…”

Section: Discussionsupporting

confidence: 89%

“…Children in the two HSU groups did not differ those with a chronic respiratory condition. 28 Another publication showed that a diagnosis of childhood asthma has been associated with being in the highest total cost quintile. 18 While these were retrospective studies focused on toddlerhood to adolescence, our study was based on a prospective birth cohort with healthy-born infants, which enabled the characterization of health care use from infancy on and efficient identification of prenatal and early-life risk factors.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Patterns of health care use related to respiratory conditions in early life: A birth cohort study with linked administrative data

Chen

Subbarao

McGihon

et al. 2019

Pediatric Pulmonology

View full text Add to dashboard Cite

Objectives To identify distinctive patterns of respiratory‐related health services use (HSU) between birth and 3 years of age, and to examine associated symptom and risk profiles. Methods This study included 729 mother and child pairs enrolled in the Toronto site of the Canadian Healthy Infant Longitudinal Development study in 2009‐2012; they were linked to Ontario health administrative databases (2009‐2016). A model‐based cluster analysis was performed to identify distinct groups of children who followed a similar pattern of respiratory‐related HSU between birth and 3 years of age, regarding hospitalization, emergency department (ED) and physician office visits for respiratory conditions and total health care costs (2016 Canadian dollars). Results The majority (estimated cluster weight = 0.905) showed a pattern of low and stable respiratory care use (low HSU) while the remainder (weight = 0.095) showed a pattern of high use (high HSU). From 0 to 3 years of age, the low‐ and high‐HSU groups differed in mean trajectories of total health care costs ($783 per 6 months decreased to $114, vs $1796 to $177, respectively). Compared to low‐HSU, the high‐HSU group was associated with a constant risk of hospitalizations, early high ED utilization and physician visits for respiratory problems. The two groups differed significantly in the timing of wheezing (late onset in low‐HSU vs early in high‐HSU) and future total costs (stable vs increased). Conclusions One in ten children had high respiratory care use in early life. Such information can help identify high‐risk young children in a large population, monitor their long‐term health, and inform resource allocation.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Patterns of health care use related to respiratory conditions in early life: A birth cohort study with linked administrative data

Chen

Subbarao

McGihon

et al. 2019

Pediatric Pulmonology

View full text Add to dashboard Cite

show abstract

“…37 A small percentage of children make up the vast majority of health care spending in inpatient settings. 12 While it is clinically and politically relevant to understand the differences between medically complex and nonmedically complex health care spending, this study was unable to do so. Ongoing research is encouraged to understand how health care spending varies across these dimensions.…”

Section: Discussionmentioning

confidence: 88%

Spending on Children’s Personal Health Care in the United States, 1996-2013

et al. 2017

View full text Add to dashboard Cite

Health care spending on children in the United States continues to rise, yet little is known about how this spending varies by condition, age and sex group, and type of care, nor how these patterns have changed over time. OBJECTIVE To provide health care spending estimates for children and adolescents 19 years and younger in the United States from 1996 through 2013, disaggregated by condition, age and sex group, and type of care. EVIDENCE REVIEW Health care spending estimates were extracted from the Institute for Health Metrics and Evaluation Disease Expenditure 2013 project database. This project, based on 183 sources of data and 2.9 billion patient records, disaggregated health care spending in the United States by condition, age and sex group, and type of care. Annual estimates were produced for each year from 1996 through 2013. Estimates were adjusted for the presence of comorbidities and are reported using inflation-adjusted 2015 US dollars.FINDINGS From 1996 to 2013, health care spending on children increased from $149.6 (uncertainty interval [UI], 144.1-155.5) billion to $233.5 (UI, 226.9-239.8) billion. In 2013, the largest health condition leading to health care spending for children was well-newborn care in the inpatient setting. Attention-deficit/hyperactivity disorder and well-dental care (including dental check-ups and orthodontia) were the second and third largest conditions, respectively. Spending per child was greatest for infants younger than 1 year, at $11 741 (UI, 10 799-12 765) in 2013. Across time, health care spending per child increased from $1915 (UI, 1845(UI, -1991 in 1996 to $2777 (UI, 2698-2851) in 2013. The greatest areas of growth in spending in absolute terms were ambulatory care among all types of care and inpatient well-newborn care, attention-deficit/hyperactivity disorder, and asthma among all conditions.CONCLUSIONS AND RELEVANCE These findings provide health policy makers and health care professionals with evidence to help guide future spending. Some conditions, such as attention-deficit/hyperactivity disorder and inpatient well-newborn care, had larger health care spending growth rates than other conditions.

show abstract

“…Regardless of the interpretation, the emerging literature seems consistent that persistently high spending is not guaranteed for most children. 16 Understanding the clinical attributes of children most likely to experience persistent high resource use might help inform clinical approaches to optimize their health. Similar to our findings, Zhong et al, 8 in a local-area study, also reported a strong correlation between a large number of chronic conditions and the likelihood of continued high resource use.…”

Section: Discussionmentioning

confidence: 99%

“…17 -23 Perhaps population health initiatives (eg, enhanced medical homes or neighborhoods for children with medical complexity, complex care networks) designed to alleviate these specific issues might benefit children who are the most likely to have persistent high resource use. 16 Most children with high inpatient costs are not hospitalized again in subsequent years. It remains unknown which reasons best explain this finding.…”

Section: Discussionmentioning

confidence: 99%

Trends in Health Care Spending for Children in Medicaid With High Resource Use

et al. 2016

Self Cite

View full text Add to dashboard Cite

CONCLUSIONS: Most children with high spending in Medicaid are without persistently high spending in subsequent years. Adolescent age, multiple chronic conditions, and certain complex chronic conditions increased the likelihood of persistently high spending; hospital and ED use decreased it. These data may help inform the development of new models of care and financing to optimize health and save resources in children with high resource use.

show abstract

Hospital Utilization Among Children With the Highest Annual Inpatient Cost

Cited by 47 publications

References 33 publications

Patterns of health care use related to respiratory conditions in early life: A birth cohort study with linked administrative data

Patterns of health care use related to respiratory conditions in early life: A birth cohort study with linked administrative data

Spending on Children’s Personal Health Care in the United States, 1996-2013

Trends in Health Care Spending for Children in Medicaid With High Resource Use

Contact Info

Product

Resources

About