• Jay G Berry, Matt Hall, David E Hall, Dennis Z Kuo, Eyal Cohen, Rishi Agrawal, Kenneth D Mandl, Holly Clifton, and John Neff.
• Division of General Pediatrics, Children's Hospital Boston, Boston, MA, USA. jay.berry@childrens.harvard.edu
• JAMA Pediatr. 2013 Feb 1; 167 (2): 170-7.

ObjectiveTo compare inpatient resource use trends for healthy children and children with chronic health conditions of varying degrees of medical complexity.DesignRetrospective cohort analysis.SettingTwenty-eight US children's hospitals.PatientsA total of 1 526 051 unique patients hospitalized from January 1, 2004, through December 31, 2009, who were assigned to 1 of 5 chronic condition groups using 3M's Clinical Risk Group software.InterventionNone.Main Outcome MeasuresTrends in the number of patients, hospitalizations, hospital days, and charges analyzed with linear regression.ResultsBetween 2004 and 2009, hospitals experienced a greater increase in the number of children hospitalized with vs without a chronic condition (19.2% vs 13.7% cumulative increase, P < .001). The greatest cumulative increase (32.5%) was attributable to children with a significant chronic condition affecting 2 or more body systems, who accounted for 19.2% (n = 63 203) of patients, 27.2% (n = 111 685) of hospital discharges, 48.9% (n = 1.1 million) of hospital days, and 53.2% ($9.2 billion) of hospital charges in 2009. These children had a higher percentage of Medicaid use (56.5% vs 49.7%; P < .001) compared with children without a chronic condition. Cerebral palsy (9179 [14.6%]) and asthma (13 708 [21.8%]) were the most common primary diagnosis and comorbidity, respectively, observed among these patients.ConclusionsPatients with a chronic condition increasingly used more resources in a group of children's hospitals than patients without a chronic condition. The greatest growth was observed in hospitalized children with chronic conditions affecting 2 or more body systems. Children's hospitals must ensure that their inpatient care systems and payment structures are equipped to meet the protean needs of this important population of children.

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