Hospital Care, 2006
The 2006 KID contains an estimated 4.5 million discharges after excluding routine newborn (DRG 391) discharges. Of these 4.5 million discharges, 7812 (95% confidence interval [CI]: 6615–9010) estimated discharges were for children dependent on LTMV and 769 770 (95% CI: 709 115–830 429) estimated discharges were related to other children with CCCs. This represents 0.17% and 17%, respectively, of pediatric discharges excluding rou-tine newborns. Aggregate inpatient charges were $1.5 billion for children dependent on LTMV and $44 billion for other CCC-related discharges. This represents 1.5% and 44%, respectively, of the ~$100 billion for the 4.5 million pediatric nonroutine newborn hospitalizations.
Characteristics of discharges for children dependent on LTMV versus other pediatric CCC-related discharges in 2006 are compared in . There was an approximately threefold longer LOS for children dependent on LTMV. Children dependent on LTMV were slightly younger on average, chiefly because of a higher proportion of children aged 1 to 4 years. Discharges for LTMV-dependent children were more often reimbursed through public programs.
Characteristics of LTMV-Dependent Discharges Versus Other Discharges Related to CCCs in 2006
LTMV discharges were significantly more likely than discharges with other CCCs to have been admitted through the emergency department or been transferred from another hospital. Although routine discharge disposition predominated for CCC-related stays, discharges for LTMV-dependent children were distinctive for fourfold higher inpatient mortality versus other children with a CCC diagnosis, and substantially higher proportions of transfers to long-term care facilities and home health care.
Differences in the hospital characteristics for LTMV-dependent children versus other children with CCCs are also presented in . Children dependent on LTMV were significantly more likely to use urban hospitals, teaching hospitals, and pediatric facilities. There were no differences in the distribution of the discharges of LTMV-dependent children versus CCC-related discharges by the hospital's census region (data not shown).
Trends in Hospital Care, 2000–2006
Characteristics of discharges for children dependent on LTMV were assessed serially in 2000, 2003, and 2006. The estimated national number of discharges for LTMV-dependent children increased from 5026 in 2000 to 7812 in 2006 (55% increase). Similarly, for LTMV-dependent children, the rate of discharge increased from 113.2 to 173.2 per 100 000 pediatric nonroutine newborn discharges ().
Trends for LTMV-Dependent Discharges From 2000 to 2006
The increasing number of discharges over time was reflected in an increase in aggregate charges for LTMV-dependent children, from $880 million nationally in 2000 to $1.5 billion in 2006 (70% increase; < .001). When the trend in increased aggregate charges was controlled for, the increase in the rate of discharges for LTMV-dependent children was no longer statistically significant (= .79), suggesting that increasing aggregate charges were chiefly related to the increasing volume of discharges.
Trends in Hospital Utilization According to Patient Age, 2000–2006
Most of the LTMV-dependent discharges (~55%) each year occurred in children younger than 1 year and between 1 and 4 years old (). In 2000, the rate of discharge was highest for children younger than 1 year and remained relatively constant over time (time trend, P = .051). In each of the other age categories, from 2000 to 2006 the rate of LTMV discharges increased, with the greatest increase occurring in the 1- to 4-year-old age group.
Mean charges by age category in the LTMV population differed significantly from each other (< .001), with the highest mean charges ($278 115 per discharge) in children younger than 1 year (). Moreover, there were statistically significant increases in the mean charges for infants younger than 1 year (P = .025) and for children aged 5 to 9 years (P = .009). Mean LOS for children younger than 1 year was longer than other age groups (P < .001), but LOS for each age group did not change over time (P = .15). Aggregate charges increased in each age group. For infants aged younger than 1 year, this is likely due to the increase in mean charges because there is no increase in the rate of discharge. In the other age groups, the increase in aggregate charges was likely due to the increase in rate of discharge, except in the 5- to 9-year-olds, in whom there may be a combined effect. Children aged younger than 1 year continued to have the highest aggregate charges ($740 million in 2006 [~50% of the aggregate charges for all LTMV-dependent discharges]).
FIGURE 1 Mean charges according to age category from 2000 to 2006. a Charges corrected to 2009 US$ using the medical consumer price index. b Statistically significant change in mean charges over time, P < .05. Statistically significant differences in mean (more ...)
Trends in Primary Payers, 2000–2006
The distribution of reimbursement according to primary payer categories also shifted significantly from 2000 to 2006 for children dependent on LTMV. The rate of discharges reimbursed by public payers (Medicaid and Medicare) increased from 58.7 to 107.2 per 100 000 pediatric nonroutine newborn discharges (83% increase, ), which contrasted sharply with a virtually unchanged rate of discharges reimbursed by private insurers (P = .32). There was a 105% increase in the aggregate charges billed to public insurers from 2000 to 2006 ($420 million to $860 million; P < .001). Private insurers saw a 25% increase in aggregate total charges, from 2000 to 2006 ($400 million to $500 million; P < .001).
Discharge Disposition, 2000–2006
Inpatient care of LTMV-dependent children was additionally complicated by mechanisms of discharge disposition. LTMV-dependent discharges had high rates of in-hospital mortality, long-term care, and home health care. The rate of in-hospital mortality was unchanged during the study period, at ~10 per 100 000 pediatric nonroutine newborn discharges (P = .32). The increased rates of discharge in the other categories generally reflected proportional increases due to overall LTMV discharge rate (). When discharge disposition was compared across different age categories, there were significantly higher rates of mortality in infants younger than 1 year and of discharges to other nonacute care facilities (eg, long-term care facilities) for teenagers 15 years of age or older. These differences are presented in for the year 2006.
FIGURE 2 Rate of discharge disposition according to age category in 2006. a Rate expressed in number of discharges associated with LTMV per 100 000 nonroutine newborn pediatric discharges. b Statistically significant differences in disposition according to age (more ...)