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. 2021 Jul 1;4(7):e2117816.
doi: 10.1001/jamanetworkopen.2021.17816.

Identifying Conditions With High Prevalence, Cost, and Variation in Cost in US Children's Hospitals

Peter J Gill  1   2 , Mohammed Rashidul Anwar  2 , Thaksha Thavam  2 , Matt Hall  3 , Jonathan Rodean  3 , Sunitha V Kaiser  4   5 , Rajendu Srivastava  6   7 , Ron Keren  8 , Sanjay Mahant  1   2 ; Pediatric Research in Inpatient Setting (PRIS) Network
Collaborators, Affiliations

Identifying Conditions With High Prevalence, Cost, and Variation in Cost in US Children's Hospitals

Peter J Gill et al. JAMA Netw Open. .

Abstract

Importance: Identifying high priority pediatric conditions is important for setting a research agenda in hospital pediatrics that will benefit families, clinicians, and the health care system. However, the last such prioritization study was conducted more than a decade ago and used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.

Objectives: To identify conditions that should be prioritized for comparative effectiveness research based on prevalence, cost, and variation in cost of hospitalizations using contemporary data at US children's hospitals.

Design, setting, and participants: This retrospective cohort study of children with hospital encounters used data from the Pediatric Health Information System database. Children younger than 18 years with inpatient hospital encounters at 45 tertiary care US children's hospitals between January 1, 2016, and December 31, 2019, were included. Data were analyzed from March 2020 to April 2021.

Main outcomes and measures: The condition-specific prevalence and total standardized cost, the corresponding prevalence and cost ranks, and the variation in standardized cost per encounter across hospitals were analyzed. The variation in cost was assessed using the number of outlier hospitals and intraclass correlation coefficient.

Results: There were 2 882 490 inpatient hospital encounters (median [interquartile range] age, 4 [1-12] years; 1 554 024 [53.9%] boys) included. Among the 50 most prevalent and 50 most costly conditions (total, 74 conditions), 49 (66.2%) were medical, 15 (20.3%) were surgical, and 10 (13.5%) were medical/surgical. The top 10 conditions by cost accounted for $12.4 billion of $33.4 billion total costs (37.4%) and 592 815 encounters (33.8% of all encounters). Of 74 conditions, 4 conditions had an intraclass correlation coefficient (ICC) of 0.30 or higher (ie, major depressive disorder: ICC, 0.49; type 1 diabetes with complications: ICC, 0.36; diabetic ketoacidosis: ICC, 0.33; acute appendicitis without peritonitis: ICC, 0.30), and 9 conditions had an ICC higher than 0.20 (scoliosis: ICC, 0.27; hypertrophy of tonsils and adenoids: ICC, 0.26; supracondylar fracture of humerus: ICC, 0.25; cleft lip and palate: ICC, 0.24; acute appendicitis with peritonitis: ICC, 0.21). Examples of conditions high in prevalence, cost, and variation in cost included major depressive disorder (cost rank, 19; prevalence rank, 10; ICC, 0.49), scoliosis (cost rank, 6; prevalence rank, 38; ICC, 0.27), acute appendicitis with peritonitis (cost rank, 13; prevalence rank, 11; ICC, 0.21), asthma (cost rank, 10; prevalence rank, 2; ICC, 0.17), and dehydration (cost rank, 24; prevalence rank, 8; ICC, 0.18).

Conclusions and relevance: This cohort study found that major depressive disorder, scoliosis, acute appendicitis with peritonitis, asthma, and dehydration were high in prevalence, costs, and variation in cost. These results could help identify where future comparative effectiveness research in hospital pediatrics should be targeted to improve the care and outcomes of hospitalized children.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Gill reported receiving grants from Physicians’ Services Incorporated Foundation, Canadian Institutes of Health Research (CIHR) and expense reimbursement from EBMLive, and CIHR Institute of Human Development, Child and Youth Health outside the submitted work. Dr Srivastava reported serving as founder for I-PASS Patient Safety Institute and receiving grants from the Agency for Healthcare Research and Quality, Patient-Centered Outcomes Research Institute, and National Institutes of Health and personal fees from Children’s Hospitals. No other disclosures were reported.

Figures

Figure.
Figure.. Prevalence, Cost, and Variation in Cost for the 25 Most Costly Conditions
Data are derived from Pediatric Health Information System database spanning from January 1, 2016, to December 31, 2019. Bubble size indicates the interhospital variation in cost per encounter per condition (ie, larger bubble size means greater variation). B, orange bubbles indicate surgical conditions; grey bubbles indicate medical and surgical conditions
See this image and copyright information in PMC

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