Most costly and prevalent reasons for hospitalization in children with medical complexity in Ontario, Canada

Background and objectives — Children with medical complexity (CMC) have chronic health conditions often associated with functional limitations. CMC comprise 1%–5% of the pediatric population. In Canada, their care accounts for one-third of pediatric health spending. We aim to describe the most costly and prevalent conditions leading to hospitalization in CMC in Ontario, Canada.

Methods — Population-based, cross-sectional study from a universally funded system utilizing health administrative databases. Children (<18 years old) with valid provincial healthcare coverage admitted to a hospital from 2014 to 2019 were included. CMC was defined using validated algorithms. Encounters were classified into clinical conditions using the Pediatric Clinical Classification System. Outcomes included condition-specific prevalence, cost, and cost rank estimated using a costing algorithm in Canadian dollars.

Results — There were 627,314 pediatric hospitalizations, costing $4.28 billion. Of these, 141,653 (23%) hospitalizations were for CMC, costing $2.25 billion (52%). Among encounters for CMC, 84,280 (60%) were for children with medical technology. One-third of hospitalizations in CMC were in community hospitals. Nearly half (1.30 million, 46%) of days in hospital were in CMC, along with 60% of intensive care unit (ICU) days (667,497 days). Low birth weight ($555.4 million), prematurity ($70.0 million), and respiratory distress of the newborn ($46.6 million) were the costliest conditions. Low birth weight (88 per 1000 encounters), chemotherapy (42 per 1000 encounters), and pneumonia (29 per 1000 encounters) were the most prevalent conditions.

Conclusions — Understanding the most costly and prevalent inpatient conditions in CMC will help to prioritize more targeted research questions and interventions to improve healthcare utilization and patient outcomes.