What Types of Hospitals Do Adolescents and Young Adults With Complex Chronic Conditions Use?

Jenkins, Ashley; Berry, Jay G.; Perrin, James M.; Kuhlthau, Karen; Hall, Matthew; Dunbar, Peter J.; Hoover, Clarissa; Garrity, Brigid; Crossman, Morgan K.; Auger, Katherine A.

doi:10.1016/j.acap.2021.12.020

Cited by 14 publications

(18 citation statements)

References 25 publications

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“…Adults hospitalized in a children's hospital were more likely to have a complex chronic condition (71.6%-85%) than their pediatric counterparts (39.1%). This finding mirrors results from another recent study, 3 likely reflecting that adults in children's hospitals represent a particular subpopulation (e.g., adults with childhoodonset conditions with specialized care needs).…”

supporting

confidence: 87%

Should we worry about the growing number of adults in children's hospitals?

Jenkins

Eckenrode

2022

Journal of Hospital Medicine

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supporting

confidence: 87%

Should we worry about the growing number of adults in children's hospitals?

Jenkins

Eckenrode

2022

Journal of Hospital Medicine

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“…We included youth older than 18 years, a demographic who may also receive care at non–pediatric hospitals. 23 However, studies have shown that pain experiences, notably catastrophizing and pain intensity, differ substantially across young adults, with those younger than 24 experiencing more catastrophizing than those older than 24 while also experiencing greater pain intensity than children. 6 Our results provide information about this unique population whose experiences may be overshadowed by the greater number of older adults within studies from purely adult populations.…”

Section: Discussionmentioning

confidence: 99%

Ureteral Stent Placement Prior to Definitive Stone Treatment Is Associated With Higher Postoperative Emergency Department Visits and Opioid Prescriptions for Youth Having Ureteroscopy or Shock Wave Lithotripsy

et al. 2023

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Study Need and Importance: Ureteral stents cause pain and urinary symptoms for most patients; however, the impact of ureteral stents among pediatric patients undergoing kidney stone surgery is poorly understood. We determined the association between ureteral stents and emergency department (ED) visits and opioid prescriptions for youth having ureteroscopy or shock wave lithotripsy (SWL) to improve the evidence base that informs clinical decision-making for the rapidly growing population of patients with early-onset kidney stone disease. What We Found: In a retrospective cohort study conducted at 6 pediatric health systems that participate in PEDSnet, a clinical research network that aggregates electronic health data, we found that ureteral stents placed before or concurrent with ureteroscopy or SWL were associated with a 33% higher rate of ED visits and a 30% higher rate of opioid prescriptions within 120 days of the index procedure (see Table ). These associations were driven by stents placed before definitive surgery and were higher in magnitude for SWL. Our results strengthen the evidence for the American Urological Association and Endourological Society guidelines, which currently are supported only by expert opinion, to recommend against routine "pre-stenting." Limitations: Limitations introduced by the retrospective observational design include selection bias, unmeasured confounding, and lack of clinically important information such as surgical indications, infection, or whether the stent was left on a string. Interpretation for Patient Care: These results suggest that performing definitive surgery, when possible, rather than "pre-stenting" could reduce the number of pediatric patients who receive stents and reduce postoperative ED visits and opioid prescriptions. To this end, studies are needed to identify situations for which stents could safely be omitted.

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“…The large variation in the percentage of adult discharges may represent individual children's hospitals developing programs targeting adult patients with certain diseases. Although the number of adults being admitted to children's hospitals continues to rise, this must also be put in the context of recent evidence 8 that about two‐thirds of adolescents and young adults with COCCs are admitted to adult hospitals. As long as there are large numbers of these patients admitted to both adult and children's hospitals, both settings need to be trained and prepared to manage them.…”

Section: Discussionmentioning

confidence: 99%

The increasing proportion of adult discharges at children's hospitals, 2004–2019

Allen

Hall

Goodman

et al. 2022

Journal of Hospital Medicine

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Significant medical advances now enable individuals with pediatric illnesses to survive into adulthood. Finding medical homes for these individuals often remains challenging. We utilized the Pediatric Health Information System to measure the variation in and growth of admissions to children's hospitals, stratified by age and payor from 2004 to 2019. We identified 8,097,081 patient encounters from 30 hospitals. Compared to children, adults discharged at children's hospitals are more likely to have a complex chronic condition, have a higher median cost, and have a longer median length of stay. Hospital-level adult discharges ranged from 1.9% to 10.1% (median 4.1%; interquartile range: 2.8%-5.4%).Significantly higher increases were seen in each adult age subgroup (18-20, 21-25, and >25 years old) compared to the pediatric age group (p < .001). The number of adults discharged from children's hospitals is increasing faster than children, impacting children's hospitals and the populations they serve.

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What Types of Hospitals Do Adolescents and Young Adults With Complex Chronic Conditions Use?

Cited by 14 publications

References 25 publications

Should we worry about the growing number of adults in children's hospitals?

Should we worry about the growing number of adults in children's hospitals?

Ureteral Stent Placement Prior to Definitive Stone Treatment Is Associated With Higher Postoperative Emergency Department Visits and Opioid Prescriptions for Youth Having Ureteroscopy or Shock Wave Lithotripsy

The increasing proportion of adult discharges at children's hospitals, 2004–2019

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