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Trends in Pediatric Hospitalizations of Children in Washington State by Insurance and Chronic Condition Status, 1991-1998
John M. Neff, MD;
Jeanette Valentine, PhD;
Alice Park, MPH;
Jan Hicks-Thomson, MSW, MPA;
Dimitri A. Christakis, MD, MPH;
John Muldoon, MPA;
Shervin Churchill, MPH
Arch Pediatr Adolesc Med. 2002;156:703-709.
Objective To examine the possible impact of changes in the organization and management
of the Medicaid program on hospitalization patterns for children with chronic
and nonchronic conditions between January 1, 1991, and December 31, 1998.
Design Longitudinal retrospective study of hospitalization patterns of children
in 4 strata: Medicaid, non-Medicaid, chronic conditions, and nonchronic conditions.
Setting Washington State.
Patients Hospital discharge abstract records for all children aged 0 to 17 years
profiled into those with and without a chronic condition, Medicaid, and non-Medicaid
using a diagnosis-based classification system.
Main Outcome Measures Hospitalization and multiple hospitalization rates and length of hospital
stay.
Results In 1991, hospitalization and multiple hospitalization rates were higher
for all Medicaid vs non-Medicaid children. From 1991 to 1998, there was a
decrease in the hospitalization and multiple hospitalization rates for Medicaid
children only. By 1998, rates for Medicaid children approximated those for
non-Medicaid children. This decrease was greater for nonchronically ill children
than for chronically ill children. Total hospitalizations in Medicaid children
decreased by 4.5%. The mean length of stay in 1991 for all Medicaid hospitalized
children was higher than that for non-Medicaid children (6.1 vs 5.1 days).
By 1998, the length of stay decreased for both groups (5.7 vs 4.9 days).
Conclusion The declines in hospitalization and multiple hospitalization rates observed
in Washington State Medicaid children from 1991 to 1998 may be the result
of many statewide efforts to increase access and improve management for this
population.
From the Center for Children With Special Needs, Children's Hospital
and Regional Medical Center, Seattle, Wash (Drs Neff and Valentine, Ms Park,
and Ms Churchill); the Department of Health, Washington State, Olympia (Ms
Hicks-Thomson); the Child Health Institute (Dr Christakis) and the Department
of Pediatrics (Drs Neff and Christakis), University of Washington, Seattle;
and the National Association of Children's Hospitals and Related Institutions,
Alexandria, Va (Mr Muldoon).
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