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- Definition: Number of hospital discharges among children ages 0-17, excluding newborns, by source of payment (e.g., among hospital discharges for California children in 2017, Medi-Cal covered the expenses for 125,263 of those hospitalizations).Percentage of hospital discharges among children ages 0-17, excluding newborns, by source of payment (e.g., among hospital discharges for California children in 2017, Medi-Cal covered the expenses for 55.1% of those hospitalizations).
- Data Source: California Office of Statewide Health Planning and Development custom tabulation (Apr. 2019).
- Footnote: Data are based on the number of hospitalizations, not the number of children hospitalized. Data are limited to hospital admissions; emergency room visits that do not result in admission are excluded. A glossary with detailed definitions of each source of payment can be found here. County-level data reflect the patient's county of residence, not the county in which the hospitalization occurred. Cases with unknown county of residence are included in California totals. Data are excluded for cases of patients with erroneous birth dates and for erroneous, unknown, or unreported sources of payment. For years prior to 2014, the notation S refers to data that have been suppressed because there were fewer than 5 cases or the percentage was less than 0.1. For years 2014 and later, S refers to data that have been suppressed because there were fewer than 11 cases, the percentage was less than 0.1, or to prevent disclosure of patient identity. N/A means that data are not available. Changes to admissions coding in 2017 could introduce variation in the exclusion of newborn cases; for more information, see the California Inpatient Data Reporting Manual.
- Measures of Hospitalizations on Kidsdata.org
On kidsdata.org, hospitalization measures reflect hospital visits in which a child is admitted for an overnight stay that includes tests, monitoring, and observation, after which they are discharged. Visits for childbirth and visits to the emergency room that do not result in admission are excluded. Data are presented for hospital discharges overall, the most common primary diagnoses for hospital stays, and sources of payment for hospitalization expenses.
- Characteristics of Children with Special Needs
- 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)
- Access to Services for Children with Special 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)
- Insurance Coverage for Children with Special Health Care Needs (Regions of 70,000 Residents or More)
- 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)
- Adequacy of Insurance Coverage Among Children with Special Health Care Needs (Regions of 70,000 Residents or More)
- Impact of Special Health Care Needs on Children & Families
- Health Care
- Visited the Emergency Room in Last Year, by Type of Insurance
- Uninsured at Any Point in Last Year
- Usual Source of Health Care
- Health Insurance Coverage (Regions of 65,000 Residents or More), by Age Group
- Health Insurance Coverage (Regions of 10,000 Residents or More), by Age Group
- Medicaid (Medi-Cal) or CHIP Coverage, by City, School District and County (Regions of 65,000 Residents or More)
- Medicaid (Medi-Cal) and CHIP Yearly Enrollment (California & U.S. Only)
- Medi-Cal Average Monthly Enrollment, by Age Group
- Receipt of Care Within a Medical Home
- 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 indicators on kidsdata.org are based on hospital discharges. These data can be useful to illuminate public safety and health trends 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 childhood 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
In 2017 there were 227,432 hospital discharges among California children ages 0-17, 22% fewer than fifteen years earlier. Nearly one in seven (14%) of these hospital stays were for a primary diagnosis of mental disease or disorder, followed by asthma/bronchitis (8%), pneumonia/pleurisy (4%), and seizures/headaches (4%). Although mental diseases and disorders have been the most common cause of childhood hospitalization statewide since 2008, there is wide variation across regions. For example, in 2017, the percentage of discharges for mental diseases and disorders among children in San Mateo County was more than 11 times greater than the percentage for children in Imperial County.
Among California children discharged in 2017, Medi-Cal covered the hospitalization expenses for more than half (55%) of these visits, compared with about one-third (35%) for private insurance. 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 low-income families and children of color, 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. California Department of Public Health. (2015). Strategic plan for asthma in California: 2015-2019. Retrieved from: https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/EHIB/CPE/CDPH Document Library/SPAC2014_7-28-15APR.pdf
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 in Children and Adolescents: Professional Resource Guide, Maternal and Child Health Digital Library
- California Dept. of Health Care Services
- Centers for Disease Control and Prevention: Children's Mental Health
- Children and Youth with Special Health Care Needs: Professional Resource Guide, Maternal and Child Health Digital Library
- Children's Hospital Association
- National Institute of Mental Health: Child and Adolescent Mental Health
- National Pediatric Readiness Project: Ensuring Emergency Care for All Children, U.S. Dept. of Health and Human Services, Emergency Medical Services for Children, Innovation and Improvement Center
- National Resource Center for Patient/Family-Centered Medical Home, American Academy of Pediatrics
- Key Reports and Research
- Costs of Pediatric Hospital Stays, 2016, 2019, Agency for Healthcare Research and Quality, HCUP Statistical Brief, Moore, B. J., et al.
- Emergency Department Visits for Injuries Sustained During Sports and Recreational Activities by Patients Aged 5-24 Years, 2010-2016, 2019, National Center for Health Statistics, National Health Statistics Reports, Rui, P., et al.
- Health Care Access Barriers Bring Children to Emergency Rooms More Frequently: A Representative Survey, 2019, Population Health Management, Taylor, T., & Salyakina, D.
- Hospitalization for Suicide Ideation or Attempt: 2008-2015, 2018, Pediatrics, Plemmons, G., et al.
- Opportunities for Improving Programs and Services for Children with Disabilities: Health Care Programs and Services, 2018, National Academies of Sciences, Engineering, and Medicine
- Overview of Pediatric Emergency Department Visits, 2015, 2018, Agency for Healthcare Research and Quality, HCUP Statistical Brief, McDermott, K. W., et al.
- Patient- and Family-Centered Care Coordination: A Framework for Integrating Care for Children and Youth Across Multiple Systems, 2018, American Academy of Pediatrics, Council on Children with Disabilities & Medical Home Implementation Project Advisory Committee
- Pediatric Readiness in the Emergency Department, 2018, American Academy of Pediatrics, American College of Emergency Physicians, & Emergency Nurses Association, Remick, K., et al.
- Social Determinants of Health and Hospital Readmission, 2017, Pediatrics, Lax, Y., et al.
- County/Regional Reports
- 2019 Santa Clara County Children's Data Book, Santa Clara County Office of Education & Kids in Common
- Important Facts About Kern’s Children, Kern County Network for Children
- Live Well San Diego Report Card on Children, Families, and Community, 2017, The Children's Initiative & Live Well San Diego
- Santa Clara County Public Health Department: Open Data Portal
- More Data Sources For Hospitalizations
- Ambulatory Health Care Data, Centers for Disease Control and Prevention
- Data Resource Center for Child and Adolescent Health, Child and Adolescent Health Measurement Initiative
- Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality
- Office of Statewide Health Planning and Development: Data and Reports
- Rates of Preventable Hospitalizations (Age<18) for Selected Medical Conditions by County, Office of Statewide Health Planning and Development
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