In 1997, 2000, 2003, and 2006, the HCUP KID provided, respectively, weighted estimates of 6.7, 6.6, 6.7, and 6.9 million discharges for children who were aged 0 to 18 years. Among children with multiple CCCs, the most frequent CCCs were cardiovascular (51.5%), congenital (46.9%), neuromuscular (37.1%), respiratory (22.2%), and malignancy (15.9%); the remaining CCCs were seen in <15% of children with multiple CCCs.
Across the 4 study years, inpatient admissions for children with CCCs accounted for an increasingly disproportionate number of pediatric hospital days and charges (). CCCs accounted for 8.9% of US pediatric admissions in 1997 and 10.1% of admissions in 2006 (trend test P < .0001). These admissions accounted for 22.7% to 26.1% of pediatric hospital days (P < .0001) and 37.1% to 40.6% of pediatric hospital charges (P < .0001). Whereas proportions of hospital days were comparable between 1997 and 2000 (P = .08), proportions increased significantly from 2000 to 2003 (P < .0001) and 2003 to 2006 (P < .0001). Whereas proportions of hospital charges decreased from 1997 to 2000 (P < .0001), proportions increased significantly from 2000 to 2003 (P < .0001) and 2003 to 2006 (P < .0001).
FIGURE 1 Inpatient health care use for US children from 1997 to 2006, by CCC. For any CCC, an increasing trend in proportion was seen across all study years (P<.0001), as well as the last 3 study years (P<.0001). Error bars (too small to be visible) (more ...)
Whereas the total number of inpatient admissions and days for either 1 CCC or multiple CCCs was similar between 1997 and 2003, both increased in 2006 (). The total number of inpatient charges for either 1 CCC or multiple CCCs increased from 1997 to 2003 and from 1997 to 2006.
Inpatient Health Care Use for US Children From 1997 to 2006, by CCC Count
Similar patterns are evident for most of the 9 CCC subtypes (). The proportion of inpatient pediatric admissions, days, and charges increased from 1997 to 2006 for every CCC except hematology (admissions, days, charges) and respiratory (charges alone). The increase in proportion of admissions, days, and charges was most for those with cardiovascular, followed by neuromuscular, congenital, and metabolic CCCs.
Inpatient health care use for US children from 1997 to 2006, by CCC. For each CCC except hematology (admissions, days, and charges) and respiratory (charges only), an increasing trend in proportion was seen across study years (P<.0001).
The patient and hospital characteristics of CCC-associated admissions are most clearly and pertinently understood by focusing on the 2006 study year (). Admissions for children with 1 and multiple CCCs compared with no CCCs was associated with patients who were older, were male, and had less self-pay and more other insurance. As numbers of CCCs increased, the proportion of admissions to urban, teaching, and children's hospitals increased.
Patient and Hospital Characteristics for US Children With and Without CCCs, 2006
As numbers of CCCs increased, all markers of use increased (). Compared with children with no CCCs, children with multiple CCCs had a threefold longer LOS, 11-fold greater charges, 60-fold higher rate of gastrostomy placement, 80-fold higher rate of tracheostomy placement, 180-fold higher rate of cerebrospinal fluid (CSF) shunt placement, and 15-fold higher inpatient mortality.
Inpatient Use for US Children With and Without CCCs, 2006
CCCs identified a high proportion of patients who underwent placement of technology-assistance devices. In 1997, CCCs identified 67.2% of 12 043 gastrostomies, 59.3% of 912 tracheostomies, and 87.5% of 7255 CSF shunts. By 2006, CCCs identified 72.7% of 14 379 gastrostomies, 75.3% of 784 tracheostomies, and 91.8% of 7100 CSF shunts. Furthermore, CCCs identified 41.9% of 27 983 admissions that ended in death in 1997 and 43.2% of 26 493 admissions that ended in death in 2006 (P = .0008).
The CCC coding scheme identifies a subset of all admissions that display certain key attributes of medical complexity. In 2006 data, CCCs demonstrated statistically significant yet limited ability to account for variation in the number of inpatient hospital days (unadjusted R2 = 0.08; adjusted R2 = 0.11) and a greater ability to account for variation in charges (unadjusted R2 = 0.11; adjusted R2 = 0.38; ). Models of CCCs alone were excellent for their discriminative ability with CSF shunt and gastrostomy tube placement with respective c statistics of 0.89 and 0.80 and modest for tracheostomy tube placement and death with respective c statistics of 0.65 and 0.64. Models of CCCs that included other covariates (age, gender, payer, hospital location, hospital region, teaching status, and NACHRI designation) displayed excellent discriminative ability for CSF shunt and gastrostomy tube placement, good for inpatient mortality, and modest for tracheostomy tube placement.
Odds of Technology Placement and Death for Children with CCCs, 2006