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Patterns and Costs of Health Care Use of Children With Medical Complexity

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Cohen, Eyal, Berry, Jay G., Camacho, Ximena, Anderson, Geoff, Wodchis, Walter, Guttmann, Astrid·2012·Pediatrics
DOI 10.1542/peds.2012-0175PMC PMC4528341
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Abstract

BACKGROUND AND OBJECTIVE: Health care use of children with medical complexity (CMC), such as those with neurologic impairment or other complex chronic conditions (CCCs) and those with technology assistance (TA), is not well understood. The objective of the study was to evaluate health care utilization and costs in a population-based sample of CMC in Ontario, Canada. METHODS: Hospital discharge data from 2005 through 2007 identified CMC. Complete health system use and costs were analyzed over the subsequent 2-year period. RESULTS: The study identified 15 771 hospitalized CMC (0.67% of children in Ontario); 10 340 (65.6%) had single-organ CCC, 1063 (6.7%) multiorgan CCC, 4368 (27.6%) neurologic impairment, and 1863 (11.8%) had TA. CMC saw a median of 13 outpatient physicians and 6 distinct subspecialists. Thirty-six percent received home care services. Thirty-day readmission varied from 12.6% (single CCC without TA) to 23.7% (multiple CCC with TA). CMC accounted for almost one-third of child health spending. Rehospitalization accounted for the largest proportion of subsequent costs (27.2%), followed by home care (11.3%) and physician services (6.0%). Home care costs were a much larger proportion of costs in children with TA. Children with multiple CCC with TA had costs 3.5 times higher than children with a single CCC without TA. CONCLUSIONS: Although a small proportion of the population, CMC account for a substantial proportion of health care costs. CMC make multiple transitions across providers and care settings and CMC with TA have higher costs and home care use. Initiatives to improve their health outcomes and decrease costs need to focus on the entire continuum of care.

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  • Integrating care can be intensive and costly, sometimes with no measurable improvement in child functional status or hospital-based utilisation.

    “First, that integrating care can be intensive and costly, sometimes with no measurable improvement in child functional status or hospital-based utilisation.29 37 38”

    From Integrated care for children and young people with special health and care needs: a systematic review (2024) · cites this paper as [37]

    The Discussion describes care coordination interventions as intensive, supporting that part of the claim. But the costs measured are costs of caring for children with medical complexity, not the cost of integrating care. The study did not measure functional status or evaluate whether integration failed to improve hospital use; the Discussion instead says observational studies suggest coordination may reduce acute-care use. (LLM, conf=0.83)

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Cited by

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Authors
Cohen, E., Berry, J. G., Camacho, X., Anderson, G., Wodchis, W., & Guttmann, A.
Affiliations
  • University of Toronto (CA)
  • Boston Children's Hospital (US)
  • Institute for Clinical Evaluative Sciences (CA)
ORCID
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
2012-12-01
Volume
130
Issue
6
Pages
e1463-e1470
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.2012-0175
PMC
PMC4528341
OpenAlex
W2016816371
Cited by
659
References
1
Citations by year
2026: 38 · 2025: 69 · 2024: 54 · 2023: 57 · 2022: 64 · 2021: 69 · 2020: 65 · 2019: 47 · 2018: 48 · 2017: 46 · 2016: 34 · 2015: 28 · 2014: 28 · 2013: 10 · 2012: 1
FWCI
51.50
Type
journal article
Language
en
Open access
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Institute for Clinical Evaluative Sciences
  • Ontario Ministry of Health and Long-Term Care
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD058092)
Topics
  • Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Keywords
children with medical complexity, health care utilization, health care costs, complex chronic conditions, neurological deficit, technology support, home care, hospital readmission, physician services, hospital discharge data, continuum of care, Ontario
MeSH terms
Adolescent, Child, Child, Preschool, Chronic Disease, Costs and Cost Analysis, Health Expenditures, Female, Health Services, Home Care Services, Humans, Infant, Infant, Newborn, Male, Medicine, Nervous System Diseases, Ontario, Patient Discharge, Patient Readmission, Referral and Consultation, Retrospective Studies, Self-Help Devices, Utilization Review, Cohort Studies, Comorbidity, Health Care Costs, Case Management

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