Interpreting Variability in the Health Care Utilization of Children With Medical Complexity.

Abstract

* Abbreviations: CCC — : complex chronic condition CMC — : children with medical complexity The prevalence of children with medical complexity (CMC) has increased in recent decades.1,2 This increase is attributable, in part, to advances in medical care that improved survival of children with chronic, congenital, or critical illnesses. These children account for a disproportionate amount of inpatient utilization. Among 6.9 million pediatric discharges in 2006, just 10.1% of pediatric admissions included children with complex chronic conditions (CCC)3; however, these admissions accounted for 26.1% of pediatric hospital days and 40.6% of pediatric hospital charges.3 Few data, however, examine variability of utilization across health care systems. In this issue of Pediatrics , Ralston et al,4 by using an all payer claims database, examine variation in health care utilization in a population-based cohort of CMC across 4 children’s hospitals in New England. This cohort was defined based on revised CCC discharge diagnosis codes3 further refined to minimize bias by excluding children with disease processes necessitating care at 1 specific hospital (eg, bone marrow transplantation). Claims data provided information on utilization across the continuum of care. Health care encounters, imaging … Address correspondence to Samir S. Shah, MD, 3333 Burnet Ave, ML 9016, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229. E-mail: samir.shah{at}cchmc.org