CLINICAL RESEARCH: ADULT CONGENITAL HEART DISEASE
Changes in Hospitalization Patterns Among Patients With Congenital Heart Disease During the Transition From Adolescence to Adulthood
Michelle Z. Gurvitz, MD, MS*,1,*,
Moira Inkelas, PhD ,
Maggie Lee, MPH,
Karen Stout, MD ,
Jose Escarce, MD, PhD and
Ruey-Kang Chang, MD, MPH||
* Department of Pediatrics, Children’s Hospital and Regional Medical Center, Seattle, Washington
University of California, Los Angeles, School of Public Health, Los Angeles, California
Department of Medicine, University of Washington, Seattle, Washington
Department of Medicine, UCLA Medical Center, Los Angeles, California
|| Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California
Manuscript received July 5, 2006;
revised manuscript received August 25, 2006,
accepted September 11, 2006.
* Reprint requests and correspondence: Dr. Michelle Z. Gurvitz, Heart Center, G-0035, Children’s Hospital and Regional Medical Center, 4800 Sand Point Way NE, Seattle, Washington 98105. (Email: Michelle.Gurvitz{at}seattlechildrens.org).
OBJECTIVES: This study was designed to evaluate hospitalization patterns of congenital heart disease (CHD) patients surrounding the transition from adolescence to adulthood.
BACKGROUND: Few population data exist on hospitalizations among adolescent and adult CHD patients.
METHODS: Patients ages 12 to 44 years with CHD were selected from the 2000 to 2003 California hospital discharge database. Patient demographics, hospitalization patterns, emergency department (ED) admissions, CHD complexity, and insurance patterns were described. Data were analyzed in 3-year age increments and compared between patients over and under age 21. Predictors of admission via the ED were determined using multivariate regression analysis.
RESULTS: There were 9,017 hospitalizations at 368 hospitals. For patients ages 12 to 20 years, 12 hospitals accounted for 70% of hospitalizations; for patients ages 21 to 44 years, 25 hospitals accounted for only 44.8% of cases. Regarding insurance, 53% of admissions were private, 44% public, and <4% were self-pay. Sixty-five percent of patients had complex CHD and 19% had a cardiac procedure during hospitalization. The proportion of patients admitted via the ED nearly doubled surrounding the transition to adulthood. The positive predictors of admission via the ED included public insurance, self-pay, and age >17 years, whereas having a procedure and being female decreased the likelihood.
CONCLUSIONS: Congenital heart disease hospitalizations occur at a wide variety of hospitals and disperse as patients enter adulthood. Those without private insurance and >17 years old are at higher risk of being admitted via the ED. These findings require further investigation to examine access to care and possible disparities, as they are important for future healthcare planning.
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Abbreviations and Acronyms
| | CHD = congenital heart disease | | ED = emergency department | | ICD-9-CM = International Classification of Diseases- Ninth Revision-Clinical Modification | | OSHPD = Office of Statewide Health Planning and Development |
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