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- Definition: Number of hospital discharges among children ages 0-17 for the ten most common primary diagnoses, excluding childbirth (e.g., among hospital discharges for California children in 2015, 2,646 were for a primary diagnosis of traumatic injury).Number hospital discharges among children ages 0-17 for the ten most common primary diagnoses, excluding childbirth, as a percentage of all child discharges, excluding newborns (e.g., among hospital discharges for California children in 2015, 1.1% were for a primary diagnosis of traumatic injury).
- Data Source: Special tabulation by California Office of Statewide Health Planning and Development (Sept. 2016).
- Footnote: Data are limited to hospital admissions only; emergency room visits that do not result in admission are excluded. County-level data reflect the patient's county of residence, not the county in which the hospitalization occurred. Primary diagnosis is the cause of the hospitalization. Coding for the following primary diagnoses changed in mid-2015: asthma/bronchitis, diabetes, fractures, metabolic/nutritional disorders, pneumonia/pleurisy, poisoning, seizures/headaches, traumatic injuries, and viral illnesses/fevers; use caution when comparing trends over time for these diagnoses. Pleurisy is the inflammation of the membrane surrounding the lung. Traumatic injuries include comas and concussions. Examples of metabolic disorders include hyper- and hypothyroidism. Nutritional disorders include a range of conditions such as obesity, diarrhea, anemia, and anorexia. A full list of mental diseases and disorders included in these data can be found at: http://www.cms.gov/icd10manual/fullcode_cms/P0325.html; this list and these data exclude disorders related to substance abuse. LNE (Low Number Event) refers to data that have been suppressed because there were fewer than 5 hospital discharges. Data are excluded for a small number of cases for patients with erroneous birth dates. Data are also excluded from county totals, but included in state totals, for a small number of cases in which the patient's county of residence is unknown.
- Measures of Hospitalizations on Kidsdata.org
On kidsdata.org, data on hospitalizations reflect all hospital visits in which a child is admitted for care, excluding visits to the emergency room and visits for childbirth. A hospital admission occurs when a child's condition is serious enough that they require extended care (i.e., an overnight stay that includes tests, monitoring, and further observation), after which they are discharged. Kidsdata.org's hospitalization measures present data on hospital discharges overall, the most common primary diagnoses for hospital stays, and sources of payment for services.
- Characteristics of Children with Special Needs
- Active California Children's Services (CCS) Enrollees, by Age Group
- Children with Special Health Care Needs (California & U.S. Only)
- Children with Four or More Functional Difficulties, by Type of Insurance (California & U.S. Only)
- Children with Major Disabilities, by City, School District and County (Regions of 65,000 Residents or More)
- Children Who Are Overweight or Obese, by Special Needs Status (California & U.S. Only)
- Insured/Uninsured Children Who Have Major Disabilities, by City, School District and County (Regions of 65,000 Residents or More)
- Insured/Uninsured Children Who Have Special Health Care Needs, by Type of Insurance (California & U.S. Only)
- Poverty Among Children with Special Health Care Needs, by Race/Ethnicity (California & U.S. Only)
- Emotional or Behavioral Difficulties Among Children with Special Health Care Needs (California & U.S. Only)
- Access to Services for Children with Special Health Care Needs
- Children's Emotional Health
- Insurance Coverage for Children with Special Health Care Needs
- Insurance Coverage for Children with Special Health Care Needs, by Insurance Status (California & Other States Only)
- Consistency of Insurance Coverage, by Special Needs Status (California & U.S. Only)
- Adequacy of Insurance Coverage Among Insured Children, by Special Needs Status (California & U.S. Only)
- Impact of Special Health Care Needs on Children & Families
- Children with Special Health Care Needs Whose Conditions Caused Family Financial Problems (California & Other States Only)
- Children with Special Health Care Needs Whose Conditions Consistently and/or Greatly Affect Their Daily Activities (California & U.S. Only)
- Children with Special Health Care Needs Whose Families Spend 11 Hours or More a Week on the Child’s Health Care (California & U.S. Only)
- Impact of Child's Special Health Care Needs on Parental Employment (California & U.S. Only)
- Out-of-Pocket Expenses for Children with Special Health Care Needs, by Adequacy of Insurance (California & U.S. Only)
- Overnight Hospital Stays Among Children with Special Health Care Needs (California Only)
- Quality of Care for Children with Special Health Care Needs
- Receipt of Family-Centered Health Care for Children with Special Health Care Needs (California & U.S. Only)
- Receipt of Care Within a Medical Home for Children with Special Health Care Needs (California & U.S. Only)
- Health Care
- Delayed or No Medical Care
- Length of Time Since Last Routine Health Check-Up
- Visited the Emergency Room in Last Year, by Type of Insurance
- Uninsured at Any Point in Last Year
- Health Insurance Coverage (Regions of 65,000 Residents or More), by Type of Insurance and Age
- Health Insurance Coverage (Regions of 10,000 Residents or More), by Type of Insurance and Age
- Medi-Cal Point-in-Time Enrollment
- Receipt of Care Within a Medical Home (Regions of 70,000 Residents or More)
- Adequate Health Services Provided at School (Staff Reported)
- Infant Mortality
- Youth Suicide and Self-Inflicted Injury
- Why This Topic Is Important
All children should have high-quality, accessible, and affordable health care, including hospital stays when needed. Children with special health care needs, in particular, may require more frequent hospitalizations and specialized, intensive medical care. Ensuring that all children have consistent access to affordable, evidence-based, well-coordinated, and family-centered care—all within the context of a “medical home”—can maximize positive outcomes (1, 2).
Hospitalization data on kidsdata.org are based on hospital discharges. These data can be useful to illuminate trends in public safety and health and can inform injury prevention and disease surveillance (3). For example, asthma is one of the most common diagnoses for hospital stays among children, statewide and nationally (4). Research examining hospital discharge data has found that asthmatic children living in neighborhoods with high levels of overcrowding and poverty are more likely to be re-admitted for hospital care than those living in less-disadvantaged areas. Asthmatic children covered by Medicaid instead of private insurance also are more likely to be re-admitted for care (4).For more information on hospitalizations, see kidsdata.org’s Research & Links section.
Sources for this narrative:
1. Health Resources and Services Administration, Maternal and Child Health Bureau. (2014). Medical home. In The health and well-being of children: A portrait of states and the nation, 2011-2012. U.S. Department of Health and Human Services. Retrieved from: http://mchb.hrsa.gov/nsch/2011-12/health/child/childs-health-care/medical-home.html
2. American Academy of Pediatrics, Council on Children with Disabilities & Medical Home Implementation Project Advisory Committee. (2014). Patient- and family-centered care coordination: A framework for integrating care for children and youth across multiple systems. Pediatrics, 133(5), e1451-e1460. Retrieved from: http://pediatrics.aappublications.org/content/133/5/e1451
3. Peters, A., et al. (2014). The value of all-payer claims databases to states. North Carolina Medical Journal, 75(3), 211-213. Retrieved from: http://www.ncmedicaljournal.com/content/75/3/211
4. Liu, S. Y., & Pearlman, D. N. (2009). Hospital readmission for childhood asthma: The role of individual and neighborhood factors. Public Health Reports, 124(1), 65-78. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2602932
- How Children Are Faring
Nearly 234,000 California children under age 18 were discharged from hospitals in 2015, a decrease of about 20% from 2002. Among those discharged in 2015, 13% had a primary diagnosis of mental disease or disorder, followed by asthma/bronchitis (8%), pneumonia/pleurisy, and seizures/headaches (4%). Statewide, mental diseases and disorders have been the most common cause of childhood hospitalization since 2008.
Among California children discharged in 2015, Medi-Cal covered the hospitalization expenses for more than half (55%) of those visits, compared to about one-third (35%) for private insurance. Medicare, self-pay, workers compensation, programs for low-income children, other government programs, and other payers covered expenses for the remaining percentage. Since 2002, the percentage of visits with costs covered by private insurers has decreased, while the percentage with costs covered by Medi-Cal has increased.
- Policy Implications
Hospital admissions and re-admissions can be reduced through effective care coordination and discharge planning, especially for children with special health care needs. Furthermore, detailed hospital discharge data can reveal the conditions and populations for which targeted care management and preventive services could have the greatest impact.
Policy options that could reduce hospital stays among children in general, and for the leading causes of hospitalization statewide—asthma and mental illness—include:
For more policy ideas and research on this topic, visit kidsdata.org's Research & Links section. Also see Policy Implications under Asthma, Health Care, and Children's Emotional Health.
- Reducing care fragmentation and inefficiency within and across health systems by establishing care coordination services that are patient- and family-centered, assessment-driven, team-based, and designed to meet the needs of children and youth while enhancing the caregiving capabilities of families (1)
- Implementing a standardized, pediatric-specific framework for the transition from hospital to home care that begins at the time of admission, involves the entire care team, engages the child's family, acknowledges the family's circumstances at home, provides clear and comprehensive documentation, and follows up with the family after discharge (2)
- Ensuring that all children have high-quality, accessible, and affordable health care to promote prevention and effective management of asthma, mental illness, and other special health care needs (3, 4)
- Promoting community-wide, integrated interventions to decrease the burden of asthma on high-risk populations, such as children of color and low-income families, including strategies to improve health insurance coverage among the uninsured and under-insured, home visiting, education and outreach, and the reduction of asthma triggers in schools, child care centers, homes, and workplaces (3)
- Adopting a comprehensive, evidence-based approach to mental health services for youth that expands and improves prevention, diagnosis, and early intervention services, while also promoting mental thriving and providing access to wellness supports for all children and families (4)
Sources for this narrative:
1. American Academy of Pediatrics, Council on Children with Disabilities and Medical Home Implementation Project Advisory Committee. (2014). Patient- and family-centered care coordination: A framework for integrating care for children and youth across multiple systems. Pediatrics, 133(5), e1451-e1460. Retrieved from: http://pediatrics.aappublications.org/content/133/5/e1451
2. Berry, J. G., et al. (2014). A framework of pediatric hospital discharge care informed by legislation, research, and practice. JAMA Pediatrics, 168(10), 955-962. Retrieved from: http://jamanetwork.com/journals/jamapediatrics/article-abstract/1899237
3. Arnesen, C., et al. (2015). Strategic plan for asthma in California 2015-2019. California Department of Public Health. Retrieved from: http://ehib.org/cehtp/cehtp.org/paper904a.html?paper_key=STRATEGIC_ASTHMA_2003
4. Murphey, D., et al. (2014). Are the children well? A model and recommendations for promoting the mental wellness of the nation’s young people. Child Trends & Robert Wood Johnson Foundation. Retrieved from: http://www.rwjf.org/en/library/research/2014/07/are-the-children-well-.html
- Websites with Related Information
- Asthma Knowledge Path, National Center for Education in Maternal and Child Health
- Children and Youth with Special Health Care Needs Knowledge Path, National Center for Education in Maternal and Child Health
- Emotional, Behavioral, and Mental Health Challenges in Children and Adolescents Knowledge Path, National Center for Education in Maternal and Child Health
- National Institute of Mental Health: Child and Adolescent Mental Health
- Key Reports and Research
- Annual Report on Health Care for Children and Youth in the United States: National Estimates of Cost, Utilization and Expenditures for Children With Mental Health Conditions, 2015, Academic Pediatrics, Torio, C. M., et al.
- Inpatient Growth and Resource Use in 28 Children's Hospitals: A Longitudinal, Multi-Institutional Study, 2013, JAMA Pediatrics, Berry, J. G., et al.
- Overview of Childhood Injury Morbidity and Mortality in the U.S. Fact Sheet, 2015, Safe Kids Worldwide
- Patient- and Family-Centered Care Coordination: A Framework for Integrating Care for Children and Youth Across Multiple Systems, 2014, Pediatrics, American Academy of Pediatrics, Council on Children with Disabilities & Medical Home Implementation Project Advisory Committee
- Preventable Hospitalizations in California 1999-2008, Office of Statewide Health Planning and Development
- Racial and Ethnic Disparities in the Health and Health Care of Children, 2013, Pediatrics, Flores, G., & American Academy of Pediatrics Committee on Pediatric Research
- County/Regional Reports
- 2017 Kern County Report Card, Kern County Network for Children
- San Diego County Report Card on Children and Families, 2015, The Children's Initiative & Live Well San Diego
- Santa Clara County Children's Agenda: 2017 Data Book, Planned Parenthood & Kids in Common
- Santa Clara County Public Health Department: Health Data and Statistics
- More Data Sources For Hospitalizations
- California Health and Human Services Open Data Portal, California Health & Human Services Agency
- Healthcare Cost and Utilization Project (HCUP), U.S. Dept. of Health and Human Services, Agency for Healthcare Research and Quality
- Maternal and Child Health Bureau: National Survey Publications and Chartbooks, U.S. Dept. of Health and Human Services
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