The challenge and opportunity of pediatric hospital care in the era of medical complexity

Abstract

The challenge and opportunity of pediatric hospital care in the era of medical complexityThe increasing number of children living with complex chronic conditions has forced pediatric healthcare systems to rethink and disrupt the status quo in healthcare delivery. Children's hospitals face the challenge of providing high-quality care for children with medical complexity (CMC), who require highly specialized, intense, and coordinated care. In this issue of the Journal of Hospital Medicine, Hall et al. provide important data on the trends in hospitalizations by the level of complexity at children's hospitals over a 10-year period. 1 Their findings of a large and increasing proportion of discharges, hospital days, and costs attributed to CMC highlight the importance of this population for health system resource planning, care delivery innovation, and education of healthcare professionals. Hall et al. performed a retrospective cohort study of inpatient pediatric encounters at US children's hospitals from 2012 to 2022.Administrative data from the Pediatric Health Information System (PHIS) database, including 43 tertiary and quaternary care pediatric hospitals across the United States, was used. The annual percent change in the number of discharges, hospital days, and costs was calculated, and linear regression was used to model the mean annual percent changes. Of the 7,817,224 discharges during the study period, CMC, defined as having at least one complex chronic condition, accounted for 40% of discharges, 67% of hospital days, and a staggering 75% of costs. CMC with 3+ complex chronic conditions accounted for 6% of all discharges, 26% of hospital days, and 31% of total costs. Additionally, an increasing number of complex chronic conditions were associated with increasing annual change in discharges, hospital days, and costs. Children with 3+ complex chronic conditions experienced the greatest annual increase in discharges (6% per year), hospital days (8% per year) and costs (7% | © 2024 Society of Hospital Medicine face in delivering high-quality care to the growing populations of CMC and children with less complex conditions while ensuring financial viability.