Pediatric hospital condition consolidation in US hospitals.

[BACKGROUND AND OBJECTIVES] While children's hospitals (CH) tend to be the locus of specialized hospital care, they also care for common conditions. There is no system to understand the distribution of hospital days within CHs and non-CHs (NCH) based on how ubiquitous conditions are across hospitals. We develop a method to classify conditions based on their commonality and consolidation within hospitals.

[METHODS] We performed a retrospective study of the 2022 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database, excluding normal newborns. For the 441 conditions, the volume of hospital days and the distribution of days across hospitals using the Hospital Days Consolidation Index (HDCI) were determined. Conditions were categorized into four groups based on k-means clustering of hospital days and HDCI.

[RESULTS] There were 1.5 million hospitalizations from 123 CH and 3366 NCH. There were 54 conditions representing 85.7% of hospital days classified as Very High Days & Very Low Consolidation (i.e., commodity conditions); 47.2% of these hospital days were at a CH. At the other extreme, there were 50 conditions classified as Very Low Days & Very High Consolidation (e.g., chronic lymphocytic leukemia) representing <1% of hospital days; 75.3% at CH. Among all hospital days for commodity conditions, 52.8% were at NCH and 47.2% were at a CH. However, for the remaining condition groups, 27.3% of days were at an NCH and 72.7% at a CH.

[CONCLUSION] We identified commodity conditions but also conditions that are consolidated, typically within CH. Consolidation can be quantified, compared, and tracked using the HDCI.