Prevalence, Cost, and Variation in Cost of Pediatric Hospitalizations in Ontario, Canada

Abstract

IMPORTANCEIdentifying 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. OBJECTIVE 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 PARTICIPANTSThis 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. MAIN OUTCOMES AND MEASURESCondition-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. RESULTSOverall, 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.

Patient, Caregiver, and Clinician Participation in Prioritization of Research Questions in Pediatric Hospital Medicine

“…Prioritizing alternatives to shorten the length of hospital stay reflects that 65% of all hospital encounters in children are at community and general hospitals. 3 , 4 Although there has been extensive research in adult care about alternatives to inpatient care, such as hospital-at-home interventions, 61 there are limited examples in pediatrics, such as home phototherapy for neonatal jaundice 62 or home oxygen therapy for bronchiolitis. 63 There was also recognition of the need to mitigate the outcomes of prolonged inpatient hospitalization, such as excessive screen time for children and separation from families.…”

“… 2 In Canada and the US, most children cared for in hospitals have medical conditions managed in general pediatric inpatient units (GPIUs). 3 , 4 Children admitted to GPIUs may have been previously healthy and are hospitalized for an acute, common illness (eg, gastroenteritis) or have chronic conditions (eg, asthma) and are hospitalized for an acute, common illness or exacerbation of the chronic disease. The specialty dedicated to caring for these hospitalized children in the GPIU is pediatric hospital medicine.…”

“…Although there have been health systems level analyses identifying high-priority conditions for research in pediatric hospital medicine based on volume, costs, and variation in care in the US and Canada, 4 , 14 , 15 , 16 little is known about which topics should be prioritized for research from the perspective of patients, families, and clinicians. Prioritization processes can help minimize avoidable research waste 17 by mitigating the mismatch between research that is conducted and research that is relevant to patients and clinicians.…”

Pediatric Clinical Classification System for use in Canadian inpatient settings

“…bronchiolitis, neonatal hyperbilirubinemia) found in children admitted in hospitals. This classification system has also been recently used to identify conditions that should be prioritized for research in hospitalized children based on the prevalence, cost, and variation in cost of pediatric hospitalizations in Ontario, Canada [ 18 ].…”

“…bronchiolitis) or have injuries (e.g. fractures) [ 18 ]. Other existing grouping methodologies for ICD-10-CA includes the ICD-10-CA chapters [ 4 ] and the CIHI Case Mix Group (CMG) [ 5 , 6 ].…”