A new JAMA Network Open study analyzing more than 26 million pediatric discharges (2000–2022) shows a major shift in the intensity, cost, and location of pediatric inpatient care — especially for children with complex chronic conditions.
1. Sharp rise in medically complex cases
Hospital discharges for children with at least one complex chronic condition increased 24.3%, while discharges for children without chronic conditions fell 9.7%, signaling a growing concentration of medically complex patients.
2. Higher use of hospital resources
In 2022, children with complex conditions represented 21.9% of discharges but accounted for 44.1% of bed days and 59.5% of hospital charges, highlighting the growing intensity and cost of their care.
3. More children with multiple chronic conditions
The number of children with two complex conditions rose 60%, and those with three or more increased 340% over the study period — showing that both complexity and severity continue to climb.
4. Care is shifting to academic centers
The share of complex-condition discharges occurring at urban teaching hospitals rose from 78% in 2000 to nearly 95% in 2022, indicating increasing centralization of complex pediatric care.
5. Medicaid coverage often falls short
Most medically complex children are covered by Medicaid, but reimbursement frequently does not cover the full cost of care. Researchers note this financial gap contributes to pediatric unit closures in community and rural hospitals.
6. Workforce and training changes are needed
The authors recommend updating staffing models, clinical team structures, and residency/fellowship training to ensure future pediatric providers can meet the rising complexity of inpatient care.
Resource: Pediatric care grows more complex, concentrated: 6 notes