Child/Adolescent Health

Recent trends in hospital use by children and youths are a mixed bag—lower for teen pregnancies, much higher for skin infections

An annual report of trends in children’s health care between 2000 and 2007 reveals that the rate of hospital discharges for children 15 to 17 years old declined by 7.8 percent. This was primarily due to a 15.8 percent decline in the rate of pregnancy and delivery discharges for girls of that age. Yet the rate of hospitalizations for skin infections doubled to 9 per 10,000 children during this period, which coincided with the first reports of community-acquired, methicillin-resistant Staphylococcus aureus (MRSA). The composite rate for hospital discharges for asthma and short-term complications of diabetes among children 5 to 17 years declined by 18.5 percent during the period. Children in the lowest-income ZIP codes had persistently higher rates of admission for these conditions. Hospital cost per discharge grew by an annual average of 4.5 percent, and Medicaid became an increasingly important payer for children’s hospital care relative to private insurance.

Nevertheless, trends were not the same in all types of hospitals, all regions, or income categories. The report was compiled by the Agency for Healthcare Research and Quality (AHRQ) researchers, Bernard Friedman, Ph.D., Terceira Berdahl, Ph.D., and Roxanne Andrews, Ph.D., and colleagues. Their findings were based on data from AHRQ’s Medical Expenditure Panel Survey and Healthcare Cost and Utilization Project, which included 9 indicators of patient safety for children in hospital care. Several measures of patient safety improved—the rates of postoperative sepsis, iatrogenic (care-caused) pneumothorax, and selected infections due to medical care declined by 14.2 percent, 17.8 percent, and 23.5 percent, respectively. These and other safety indicators are some of the many Quality Indicators (QIs) developed by AHRQ, which measure health care quality using readily available hospital inpatient administrative data.

The QIs can be used to highlight potential quality concerns, identify areas that need further study and investigation, and track changes over time. For more information on AHRQ’s QIs, go to http://www.qualityindicators.ahrq.gov/. More details are in “Annual Report on Health Care for Children and Youth in the United States: Focus on trends in hospital use and quality,” by Dr. Friedman, Dr. Berdahl, Lisa A. Simpson, M.D., B.Ch., M.P.H., and others in the July/August 2011 Academic Pediatrics 11(4), pp. 263–279. Reprints (Publication No. 11-R061) are available from the AHRQ Publications Clearinghouse.

Research Activities, November 2011: Child/Adolescent Health: Recent trends in hospital use by children and youths are a mixed bag—lower for teen pregnancies, much higher for skin infections