U.S. children's hospitals treating more complex, expensive conditions

By Alan Mozes HealthDay Reporter

THURSDAY, Dec. 27 (HealthDay News) -- An in-depth profile of many U.S. children's hospitals suggests that children with complex chronic diseases such as cerebral palsy are taking up an increasingly larger share of hospital resources.

The finding raises concerns about how well freestanding pediatric hospitals can handle a rapidly growing group of patients that are, by definition, difficult and expensive to care for.

"Children with medical complexity are often relying on a myriad of services to get their health care needs met," said study lead author Dr. Jay Berry, an assistant professor of pediatrics with Boston Children's Hospital and Harvard Medical School in Boston. "These services include primary and specialty care, home nursing and case management."

Most children seen in hospitals are healthy overall, but require treatment for an acute sickness, such as pneumonia, the authors stressed. But a minority of children suffer from lifelong chronic sickness, such as those born with heart disease; neurological diseases such as cerebral palsy, which impairs muscle tone and movement; or Down syndrome, a chromosomal disorder that affects the nervous system and may include heart, hearing and skeletal problems.

It's not unusual for children with complex conditions to see 10 to 15 different care providers throughout the year, Berry said. "They tend to have a lot of appointments," he added.

Two main factors are driving up hospital use by children with medically complex conditions, he noted. "One, survival for these children has improved. They are living longer, but at the expense of developing secondary co-morbid conditions that often require hospital care for treatment," he said.

"Two, care coordination for these children is inadequate," he added. "With better care coordination and proactive care planning, we believe that the children would be healthier and not need to come into the hospital so often."

Berry and his colleagues discussed their findings in the Dec. 24 online issue of the journal Archives of Pediatrics & Adolescent Medicine.

To assess trends in admissions at children's hospitals, Berry's team studied data for more than 1.5 million pediatric patients hospitalized at least once at one of 28 urban pediatric hospitals between 2004 and 2009.

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U.S. children's hospitals treating more complex, expensive conditions