Dr Olasin has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device


, et al
Increasing prevalence of medically complex children in US hospitals
; doi:

Investigators from Arkansas used national data to evaluate changes in hospitalization rates for children aged 8 days to 4 years with complex chronic conditions (CCC) from 1991 through 2005. Medically complex children were defined as individuals in a designated chronic condition category involving more than one organ system, such as children with a specific condition (eg, cerebral palsy [CP] or bronchopulmonary dysplasia [BPD]) and an additional chronic condition. The CCC included multisystem specific comorbidities: neuromuscular, cardiovascular, respiratory, renal, gastrointestinal, hematologic, metabolic, other, and malignancy. Discharge data were analyzed from the Nationwide Inpatient Sample (NIS), an Agency for Healthcare Research and Quality database created as part of the Healthcare Cost and Utilization Project, which includes 100% of discharge data from approximately 1,000 hospitals nationally.

Analysis was performed of each category individually, as well as of children with a condition in more than one category, children with CP and BPD individually, and children with CP and BPD individually with one or more CCC. All hospitalized children in each illness category aged 8 days to 4 years for each year comprised the numerator of the analysis. All children in these age groups nationally were used as the denominator for rate determination. Logistic regression adjusted with demographic variables was used to analyze for linear trends over time. The number of pediatric hospitalizations for children aged 8 days to 4 years for the 15-year period was 61.1 million, of which 2.8 million met the study criteria as CCC. Hospitalization rates for children with a single CCC in cardiovascular, respiratory, renal, metabolic, or other category and for children with more than one CCC increased by 5.5% and 17.6% per year, respectively, during the study period. Hospitalization rates increased for children with CP and one CCC (10.41% increase per year) and BPD alone (7.07% increase per year). BPD and one CCC demonstrated the largest single increase at 22.5% per year during this period. The authors conclude that increasing survival and better home supportive therapy may reduce longterm admissions, and may increase frequency of short-term acute care utilization for children with CCCs. They propose development of an inpatient medical home model.

Inpatient medical homes complement existing models of acute care delivery.1,2 Physicians who care for children with CCC in the 21st century will need to manage progressively more complex physiologic conditions in an anticipatory manner. This study analyzed the impact on pediatric admissions for a specific age group. More than 500,000 individuals with special health care needs who would not have survived to age 21 fifteen years ago are now turning 21 annually.3–5 It can be expected...

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