Abstract
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. 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. 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. 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. 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). 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.
Highlights
Examples of conditions high in prevalence, cost, and variation in cost included major depressive disorder, scoliosis, acute appendicitis with peritonitis, asthma, and dehydration. This cohort study found that major depressive disorder, scoliosis, acute appendicitis with peritonitis, asthma, and dehydration were high in prevalence, costs, and
The study used the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)[7] codes to identify the primary discharge diagnosis, but in 2015, the US transitioned to International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM),[8,9] which has improved specificity and increased granularity.[8,10]
We aimed to identify conditions that should be prioritized for comparative effectiveness research in hospital pediatrics
Summary
The hospital is a high-cost, resource-intensive setting where there is increasing pressure to provide safe and high-quality care efficiently for children.[1,2] Despite the high cost of hospital care, there are still many areas in pediatric hospital care that lack high-quality evidence, including the treatment of children with common conditions and those with complex health care needs.[3,4] Comparative effectiveness research, which aims to determine which clinical and health care delivery strategies are most effective in real-word settings, is important to inform practice, reduce unnecessary practice variation, and improve health outcomes.[5]Prioritizing topics for comparative effectiveness research in hospital pediatrics is an important step to develop a research agenda that will benefit children and families, clinicians, and the health care system. The study used the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)[7] codes to identify the primary discharge diagnosis, but in 2015, the US transitioned to International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM),[8,9] which has improved specificity and increased granularity.[8,10] The Institute of Medicine recommends setting the prioritization criteria every 5 years and having the priority-setting cycle (ie, producing a rank-order list of conditions to be prioritized) every 3 years.[11] A 2011 review by Dubois and Graff,[12] which developed a framework for setting priorities for research, suggested updating research prioritization using the same frequency. It is important to update the prioritization regularly.[12]
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