Inpatient care for children with complex health issues has grown significantly more intensive over the past 20 years, according to a study published Dec. 2 in JAMA Network Open.
A national group of pediatric health services researchers conducted the study, analyzing more than 26 million pediatric hospital discharges using data from the Kids’ Inpatient Database from 2000 to 2022.
Six notes:
1. Hospital discharges for children with at least one complex chronic condition increased by 24.3% over the study period, while discharges for children without chronic conditions fell by 9.7%.
2. In 2022, children with complex chronic conditions made up 21.9% of discharges but accounted for 44.1% of bed days and 59.5% of hospital charges — a disparity researchers said highlights the growing intensity and cost of inpatient pediatric care.
3. The number of children with two complex chronic conditions rose 60% between 2000 and 2022, while the number with three or more increased by 340%.
4. The share of pediatric discharges for children with at least one complex chronic condition occurring at urban teaching hospitals rose from 78% in 2000 to nearly 95% in 2022, indicating a growing concentration of complex care in academic centers.
5. While most hospitalizations for medically complex children are covered by Medicaid, researchers noted that reimbursement often fails to cover the full cost of care, a factor that contributes to pediatric unit closures in community and rural hospitals.
6. The authors recommended changes to hospital staffing models and clinical team structures, along with residency and fellowship programs, to ensure future pediatricians and subspecialists are equipped to care for increasingly complex patients.
“We need pediatric-specific Medicaid policies and payment structures that recognize these children aren’t the same as the average adult Medicaid population,” said lead author Nathaniel Bayer, MD, associate professor at Rochester, N.Y.-based Golisano Children’s Hospital, in a Dec. 2 news release. “If we want to sustain high-quality pediatric inpatient care, reimbursement and workforce investments have to follow from the public and private payers.”
