Inpatient Health Care Use Among Adult Survivors of Chronic Childhood Illnesses in the United States

Many patients with chronic childhood diseases are now living to be adults. Some continue to use pediatric hospitals, despite recommendations by medical associations that they transition into adult-care systems. This study examined hospital use, including length of stay (LOS) and incurred hospital charges, by adults suffering from four pediatric-onset chronic diseases: complex congenital heart disease (CCHD), cystic fibrosis (CF), spina bifida (SB) and sickle cell disease (SCD). Data came from the 2002 Nationwide Inpatient Sample (NIS), the largest publicly available all-payer inpatient database in the U.S.

Key Findings:

  • Patients with CCHD and CF spent more time in pediatric hospitals as compared with those patients in adult hospitals. LOS was similar between adult and pediatric hospitals for SCD or SB patients.
  • For all four diseases, charges were significantly higher in pediatric hospitals; LOS explained approximately 60 percent of charge differences for CF and 44 percent for CCHD. For SB and SCD, the figure was less than 10 percent.
  • When patients were age-separated, findings were even more pronounced, with patients 18–35 having longer LOS and higher charges than pediatric patients.
  • The authors hypothesized that comorbidity is higher in older patients because of the progressive nature of many chronic diseases, which might explain longer LOS in these patients.
  • Other hypotheses include: pediatric hospitals have higher staffing ratios and more ancillary support services, both of which could result in higher charges per patient; and operational costs per discharge may be higher in pediatric hospitals.

Limitations of the study include the inability to determine which, if any, of the above hypotheses are correct; the study is observational and not prospective, and not all confounding factors can be accounted for; data in the NIS are based on discharges and therefore readmission rates cannot be assessed, which could mean that longer LOS results in fewer readmissions might result in annual per person charges being lower than they appear in this study. Further research should focus on how these differences translate into differences in care quality, decreased morbidity, or future savings.