The Dartmouth Institute for Health Policy & Clinical Practice recently completed a follow-on study to its 2013 Dartmouth Atlas of Children’s Health Care in Northern New England. The new report focuses on children with medical complexity (CMC) — those with medical fragility and intensive care needs due to life-altering chronic illnesses, severe neurologic conditions that impair their activities, and/or technology dependencies for daily activities. Recognizing that CMC represent a very small percentage of the overall pediatric population but account for a large proportion of pediatric healthcare utilization and costs, Dartmouth Institute researchers focused on identifying, characterizing, and examining their patterns of care in northern New England.

This retrospective, observational study, which will appear in the upcoming November 1 issue ofPediatrics, is based on 2007-2010 data from the statewide all-payer claims databases of Maine, New Hampshire, and Vermont, which were integrated and enhanced with HEDIS measures by Onpoint Health Data in support of Dartmouth’s Pediatric Atlas.

Findings of the new follow-on study suggest that where children received their care – at an academic children’s hospital versus a regional hospital, for example – strongly influenced the type and quantity of care provided, even after controlling for a number of patient characteristics, including differences in age, diagnoses, and other factors. For example, children cared for by one children’s hospital spent almost twice as many days in the intensive care unit compared to a similar children's hospital in a different city. The use of imaging, other diagnostic tests, electrocardiography, and head MRIs also varied significantly across hospitals.

The study is “the first analysis that [the Dartmouth Institute] know[s] of to examine between-center variation in the care for children with medical complexity” and was designed to potentially help specialized children’s hospitals better evaluate resource management of this high-utilization, high-cost CMC population. The authors mention, for example, the possibility of transitioning the locus of care for the CMC population to community hospitals, which tended to offer lower-cost treatments, possibly yielding further cost savings.

According to the Dartmouth Institute researchers, the study highlights the need for further identifying best practices for this apparently growing patient population in order to identify opportunities for additional quality improvements and cost reductions in their care.