BOSTON – A new survey by Children’s Hospital Boston shows that neurologically impaired children, though still a relatively small part of the overall population, account for increasing hospital resources, particularly within children's hospitals.
The study analyzed more than 25 million pediatric hospitalizations from 1997, 2000, 2003 and 2006 using data from the Agency for Healthcare Research and Quality Kids' Inpatient Database (KID). Of the hospitalizations studied, 1.3 million were for children with neurologic conditions, primarily cerebral palsy and epilepsy.
Within children's hospitals, neurologically impaired children accounted for an increasing proportion of resources. In 2006, they accounted for 25 percent of all bed days (up from 21.8 percent in 1997) and 29 percent of hospital charges ($12 billion, up from 27 percent in 1997).
Further, the study noted, children with neurologic diagnoses were admitted more to children's hospitals and less to community hospitals. At non-children's hospitals, the patients within this population declined from 3 percent in 1997 to 2.5 percent in 2006. At children's hospitals, their admissions increased from 11.7 percent of admissions in 1997 to 13.5 percent in 2006.
"Our findings suggest that children's and non-children's hospitals are caring for increasingly different populations of children," said first author Jay Berry, MD, an attending physician in the Complex Care Service at Children's Hospital Boston in a press releases announcing the study results. "Children with neurologic impairment tend to require expensive, lengthy hospitalizations. As policymakers increasingly focus on healthcare costs, we must be careful to not jeopardize the care these children receive as health reforms are considered."
Children with severe neurologic conditions commonly have additional health problems, such as respiratory and feeding problems, that make their care needs more complex. Yet studies indicate that pediatric providers often feel unprepared to assess and treat them. Because of this the researchers noted that improved care delivery and coordination could lead to reduced hospital utilization.
"We're nervous that many children with neurologic impairment are without a healthcare provider who is taking charge of their care and making sure that all of their healthcare needs are adequately addressed," added Berry.
In the study, published this week online at PLoS Medicine, inpatient utilization increased most markedly among neurologically impaired adolescents. Across all hospitals, this group of children had a 28 percent increase in hospitalizations from 1997 to 2006, while children of the same age without neurologic diagnoses had an 8.4 percent decrease in hospitalizations. One reason for this increase among the adolescent population’s hospitalizations is due to the children outgrowing their pediatric providers and experiencing difficulty in finding adult providers to care for them.
The study was supported by a Harvard Medical School Eleanor & Miles Shore Scholar/Children's Hospital Boston Junior Faculty Career Development Fellowship, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Children's Health Research Center at the University of Utah and the Primary Children's Medical Center Foundation.
