Impact of children with complex chronic conditions on costs in a tertiary referral hospital
DOI:
https://doi.org/10.11606/s1518-8787.2022056004656Keywords:
Child, Chronic Disease, Tertiary Healthcare, trends, Hospitalization, economicsAbstract
OBJECTIVES To investigate the impact of complex chronic conditions on the use of healthcare resources and hospitalization costs in a pediatric ward of a public tertiary referral university hospital in Brazil. METHODS This is a longitudinal study with retrospective data collection. Overall, three one-year periods, separated by five-year intervals (2006, 2011, and 2016), were evaluated. Hospital costs were calculated in three systematic samples of 100 patients each, consisting of patients with and without complex chronic conditions in proportion to their participation in the studied year. RESULTS Over the studied period, the hospital received 2,372 admissions from 2,172 patients. The proportion of hospitalized patients with complex chronic conditions increased from 13.3% in 2006 to 16.9% in 2016 as a result of a greater proportion of neurologically impaired children, which rose from 6.6% to 11.6% of the total number of patients in the same period. Patients’ complexity also progressively increased, which greatly impacted the use of healthcare resources and costs, increasing by 11.6% from 2006 (R$1,300,879.20) to 2011 (R$1,452,359.71) and 9.4% from 2011 to 2016 (R$1,589,457.95). CONCLUSIONS Hospitalizations of pediatric patients with complex chronic conditions increased from 2006 to 2016 in a Brazilian tertiary referral university hospital, associated with an important impact on hospital costs. Policies to reduce these costs in Brazil are greatly needed.
References
Cohen E, Kuo DZ, Agrawal R, Berry JG, Bhagat SKM, Simon TD, et al. Children with medical complexity: an emerging population for clinical and research initiatives. Pediatrics. 2011;127(3):529-38. https://doi.org/10.1542/peds.2010-0910
Cohen E, Berry JG, Camacho X, Anderson G, Wodchis W, Guttmann A. Patterns and costs of health care use of children with medical complexity. Pediatrics. 2012;130(6):e1463-70. https://doi.org/10.1542/peds.2012-0175
Simon TD, Berry J, Feudtner C, Stone BL, Sheng X, Bratton SL, et al. Children with complex chronic conditions in inpatient hospital settings in United States. Pediatrics. 2010;126(4):647-55. https://doi.org/10.1542/peds.2009-3266
Lacerda AF, Oliveira G, Cancelinha C, Lopes S. [Hospital inpatient use in Mainland Portugal by children with complex chronic conditions (2011-2015)]. Acta Med Port. 2019;32(7-8):488-98. Portuguese. https://doi.org/10.20344/amp.10437
Pinto M, Gomes R, Tanabe RF, Costa ACC, Moreira MCN. Analysis of the cost of care for children and adolescents with medical complex chronic conditions. Cien Saude Colet. 2019;24(11):4043-52. https://doi.org/10.1590/1413-812320182411.08912018
Moura EC, Moreira MCN, Menezes LA, Ferreira IA, Gomes R. Complex chronic conditions in children and adolescents: hospitalizations in Brazil, 2013. Cien Saude Colet. 2017;22(8): 2727-34. https://doi.org/10.1590/1413-81232017228.01992016
Feudtner C, Feinstein JA, Zhong W, Hall M, Dai D. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr. 2014;14:199. https://doi.org/10.1186/1471-2431-14-199
Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214-23. https://doi.org/10.1111/j.1469-8749.1997.tb07414.x
Almeida AMG. [Hospital cost management]. Juiz de Fora, MG: Universidade Federal de Juiz de Fora; 2011 [cited 2021 Aug 9]. Portuguese. Available from: https://www.ufjf.br/oliveira_junior/files/2011/08/Gest%C3%A3o-de-Custos-Hospitalares.pdf
Bonacim CAG, Araújo AMP. Gestão de custos aplicada a hospitais universitários públicos: a experiência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da USP. Rev Adm Publica. 2010;44(4):903-31. Portuguese. https://doi.org/10.1590/S0034-76122010000400007
Hendriks ME, Kundu P, Boers AC, Bolarinwa OA, Te Pas MJ, Akande TM, et al. Step-by-step guideline for disease-specific costing studies in low- and middle-income countries: a mixed methodology. Glob Health Action. 2014;7(1):23573. https://doi,org/10.3402/gha.v7.23573
Instituto Brasileiro de Geografia e Estatística. Inflação. Rio de Janeiro: IBGE; 2021 [cited 2021 Feb 1]. Available from: http://www.ibge.gov.br/explica/inflacao.php
Berry JG, Hall M, Hall DE, Kuo DZ, Cohen E, Agrawal R, et al. Inpatient growth and resource use in 28 children’s hospitals: a longitudinal, multi-institutional study. JAMA Pediatr. 2013;167(2):170-7. https://doi.org/10.1001/jamapediatrics.2013.432
Burns KH, Casey PH, Lyle RE, Mac Bird T, Fussell JJ, Robbins JM. Increasing prevalence of medically complex children in US hospitals. Pediatrics. 2010;126(4):638-46. https://doi.org/10.1542/peds.2009-1658
Burke RT, Alverson B. Impact of children with medically complex conditions. Pediatrics. 2010;126(4):789-90. https://doi.org/10.1542/peds.2010-1885
Yuan JX, McGowan M, Hadjikoumi I, Pant B. Do children with neurological disabilities use more inpatient resources: an observational study. Emerg Themes Epidemiol. 2017;14:5. https://doi.org/10.1186/s12982-017-0059-1
Flores JC, Carrillo D, Karzulovic L, Cerda J, Araya G, Matus MS, et al. [Children with special health care needs: prevalence in a pediatric hospital and associated risks]. Rev Med Chile. 2012;140(4):458-65. Spanish. https://doi.org/10.4067/S0034-98872012000400006
Berry JG, Poduri A, Bonkowsky JL, Zhou J, Graham DA, Welch C, et al. Trends in resource utilization by children with neurological impairment in the United States inpatient health care system: a repeat cross-sectional study. PLoS Med. 2012;9(1):e1001158. https://doi.org/10.1371/journal.pmed.1001158
Gold JM, Hall M, Shah SS, Thomson J, Subramony A, Mahant S, et al. Long length of hospital stay in children with medical complexity. J Hosp Med. 2016;11(11):750-6. https://doi.org/10.1002/jhm.2633
Leyenaar JK, Lagu T, Shieh MS, Pekow PS, Lindenauer PK. Management and outcomes of pneumonia among children with complex chronic conditions. Pediatr Infect Dis J. 2014;33(9):907-11. https://doi.org/10.1097/INF.0000000000000317
Ralston SL, Harrison W, Wasserman J, Goodman DC. Hospital variation in health care utilization by children with medical complexity. Pediatrics. 2015;136(5):860-7. https://doi.org/10.1542/peds.2014-3920
Russell CJ, Mack WJ, Schrager SM, Wu S. Care variations and outcomes for children hospitalized with bacterial tracheostomy-associated respiratory infections. Hosp Pediatr. 2017;7(1):16-23. https://doi.org/10.1542/hpeds.2016-0104
Silber JH, Rosenbaum PR, Pimentel SD, Calhoun S, Wang W, Sharpe JE, et al. Comparing resource use in medical admissions of children with complex chronic conditions. Med Care. 2019;57(8):615-24. https://doi.org/10.1097/MLR.0000000000001149
Thomson J, Hall M, Berry JG, Stone B, Ambroggio L, Srivastava R, et al. Diagnostic testing and hospital outcomes of children with neurologic impairment and bacterial pneumonia. J Pediatr. 2016;178:156-63.e1. https://doi.org/10.1016/j.jpeds.2016.07.024
Cohen E, Berry JG, Sanders L, Schor EL, Wise PH. Status complexicus? The emergence of pediatric complex care. Pediatrics. 2018;141 Suppl 3:S202-11. https://doi.org/10.1542/peds.2017-1284E
Colleti Junior J, Prata-Barbosa A, Lima-Setta F, Araujo OR, Horigoshi NK, Cesar RG, et al. Prevalence and functional status of children with complex chronic conditions in Brazilian PICUs during the COVID-19 pandemic. J Pediatr (Rio J). 2021 Dec 31:S0021-7557(21)00173-X. https://doi.org/10.1016/j.jped.2021.12.004 Epub ahead of print.
Moreira MCN, Albernaz LV, Sá MRC, Correia RF, Tanabe RF. [Guidelines for a line of care for children and adolescents with complex chronic health conditions]. Cad Saude Publica. 2017;33(11):e00189516. Portuguese. https://doi.org/10.1590/0102-311X00189516
Simon TD, Mahant S, Cohen E. Pediatric hospital medicine and children with medical complexity: past, present, and future. Curr Probl Pediatr Adolesc Health Care. 2012;42(5):113-9. https://doi.org/10.1016/j.cppeds.2012.01.002
Berry JG, Agrawal RK, Cohen E, Kuo DZ. The landscape of medical care for children with medical complexity. Alexandria, VA: Children’s Hospital Association; 2013 [cited 2021 Mar 15]. 15 p. Available from: http://www.columbia.edu/itc/hs/medical/residency/peds/new_compeds_site/pdfs_new/PL3%20new%20readings/Special_Report_The_Landscape_of_Medical_Care_for_Children_with_Medical_Complexity.pdf
Published
Issue
Section
License
Copyright (c) 2022 Regina Maria Antunes Mattiello, Antonio Pazin-Filho, Davi Casale Aragon, Palmira Cupo, Ana Paula de Carvalho Panzeri Carlotti
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
Funding data
-
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Grant numbers financing code: 001
